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Douedari Y, Alhaffar M, Khanshor A, Alrashid Alhiraki O, Marzouk M, Howard N. ' COVID-19 is just another way to die…': a qualitative longitudinal study of frontline COVID-19 response governance across Syria. BMJ Glob Health 2023; 8:e013199. [PMID: 38084479 PMCID: PMC10711850 DOI: 10.1136/bmjgh-2023-013199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/12/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Governance of COVID-19 responses has been challenging for all countries. Syria has been particularly challenged due to protracted multiparty conflict and debilitated health systems fragmented across different areas of control. To improve response governance, better understanding of frontline response policy implementation across the country is needed. This study thus explored perspectives of COVID-19 response governance among frontline healthcare providers over time and across major areas of control. METHODS We used a qualitative longitudinal study design, conducting five rounds of remote semistructured interviews in Arabic (ie, approximately eight interviews each in March 2020, July 2020, September 2020, December 2020 and September 2021) with 14 purposively sampled public and private healthcare providers in the three main areas of control (ie, opposition-controlled area, Autonomous Administration-controlled area and al-Assad government-controlled area (GCA)). We conducted integrative thematic analysis in Arabic within and across geography and time. RESULTS Almost all participants across all areas and rounds expressed distrust of local health authorities and dissatisfaction with COVID-19 response governance. This was most apparent in initial rounds and in GCA. Response planning was identified as insufficient, non-participatory and non-transparent. Limited infrastructure and resources were the main challenges across time, though anticipated rapid virus spread and health systems' collapse did not occur and participant optimism increased over time. Public adherence to prevention measures varied-initially weak due to general scepticism, increasing after first cases were confirmed and then fluctuating with case numbers and challenges of insecurity and misinformation. Perceptions of COVID-19 vaccination varied, with low uptake and hesitancy attributed to misinformation, disinformation and disinterest. Suggested improvements to COVID-19 response governance focused on strengthening health systems' capacity and coordination. CONCLUSION This is a unique longitudinal study of COVID-19 responses. Addressing transparency and misinformation should be a first step to improving public engagement and trust and thus response governance for health emergencies in Syria.
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Affiliation(s)
- Yazan Douedari
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Free Aleppo University, Azaz, Syria
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Mervat Alhaffar
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Ahmad Khanshor
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Omar Alrashid Alhiraki
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
- Acute Medicine Department, United Lincolnshire Hospitals NHS Trust, Lincoln, UK
| | - Manar Marzouk
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
| | - Natasha Howard
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine Faculty of Public Health and Policy, London, UK
- Syria Research Group, London School of Hygiene & Tropical Medicine and NUS Saw Swee Hock School of Public Health, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Deng Q, Xiao X, Zhu L, Cao X, Liu K, Zhang H, Huang L, Yu F, Jiang H, Liu Y. A national risk analysis model (NRAM) for the assessment of COVID-19 epidemic. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:1946-1961. [PMID: 36617495 DOI: 10.1111/risa.14087] [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: 05/30/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
COVID-19 has caused a critical health concern and severe economic crisis worldwide. With multiple variants, the epidemic has triggered waves of mass transmission for nearly 3 years. In order to coordinate epidemic control and economic development, it is important to support decision-making on precautions or prevention measures based on the risk analysis for different countries. This study proposes a national risk analysis model (NRAM) combining Bayesian network (BN) with other methods. The model is built and applied through three steps. (1) The key factors affecting the epidemic spreading are identified to form the nodes of BN. Then, each node can be assigned state values after data collection and analysis. (2) The model (NRAM) will be built through the determination of the structure and parameters of the network based on some integrated methods. (3) The model will be applied to scenario deduction and sensitivity analysis to support decision-making in the context of COVID-19. Through the comparison with other models, NRAM shows better performance in the assessment of spreading risk at different countries. Moreover, the model reveals that the higher education level and stricter government measures can achieve better epidemic prevention and control effects. This study provides a new insight into the prevention and control of COVID-19 at the national level.
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Affiliation(s)
- Qing Deng
- School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing, China
| | - Xingyu Xiao
- School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing, China
| | - Lin Zhu
- School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing, China
| | - Xue Cao
- School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing, China
| | - Kai Liu
- School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing, China
| | - Hui Zhang
- Deparment of Engineering Physics, Tsinghua University, Beijing, China
| | - Lida Huang
- Deparment of Engineering Physics, Tsinghua University, Beijing, China
| | - Feng Yu
- School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai, China
| | - Huiling Jiang
- School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing, China
| | - Yi Liu
- School of Public Security and Traffic Management, People's Public Security University of China, Beijing, China
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Hu M, Xu Y, Bu D, Luo K, Chang L, Mao C. The psychological stress response of COVID-19 to medical staff and prevention: A large sample study from China. Front Psychol 2023; 14:1125847. [PMID: 37034918 PMCID: PMC10074311 DOI: 10.3389/fpsyg.2023.1125847] [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: 12/16/2022] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Objectives In the face of the COVID-19 pandemic, medical staff in China were more likely to suffer from psychological problems. By investigating the actual state of psychological stress response of medical staff during the COVID-19 outbreak, the study discussed and analyzed the influencing factors of different psychological states in order to prevent the occurrence of serious adverse emotional events in medical staff. Methods In the Xiangyang Central Hospital, 1,466 medical staff members have adopted the Psychological Questionnaire for Emergencies Events of Public Health (PQEEPH), which includes questions about depression, neurasthenia, fear, obsessive anxiety, and hypochondriac disorders. The questionnaire also asks about gender, age, education level, health, department, position, and whether personnel exposure history correlation analysis has been confirmed. Results The survey revealed that 55% had depression, 26.7% had neurasthenia, 95% had fear, 47.9% had obsessive anxiety, and 69.3% had hypochondria. The effects of depression and hypochondriac emotional stress were significantly greater in female workers than in male workers (p < 0.05). Those with higher educational levels had a stronger emotional stress response. Medical professionals with or without contact histories, those who were suspected or confirmed, as well as those in various positions and departments, all demonstrated significant differences in their stress emotions (p < 0.05). Conclusion Emotional stress affected medical professionals, especially doctors and nurses, who were on the front lines of clinical work in the face of significant public health emergencies. Therefore, to reduce the stress burden and enhance mental health on medical staff, hospitals were suggested to improve their emergency management practices. In addition, the sensitization knowledge training and psychological counseling for front-line clinical staff should be strengthened.
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Affiliation(s)
- Mei Hu
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- Comprehensive Stroke Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Yuan Xu
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- Comprehensive Stroke Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- *Correspondence: Yuan Xu,
| | - Dengying Bu
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- Comprehensive Stroke Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Kai Luo
- School of Food Science and Technology and School of Chemical Engineering, Hubei University of Arts and Science, Xiangyang, China
- Kai Luo,
| | - Liying Chang
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- Comprehensive Stroke Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Chun Mao
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- School of Clinical Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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de Melo MDCB, Ferri PM, de Vasconcelos MMA, Reis ZSN, Godoy SCB, Palmeira VA, Rocha G, Torres RM, Tupinambás U. COVID-19: Distance learning to empower educators and health assistants in rural areas. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:183. [PMID: 36003246 PMCID: PMC9393942 DOI: 10.4103/jehp.jehp_1303_21] [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: 09/03/2021] [Accepted: 10/29/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Educators and health assistants can act as key players in controlling the pandemic. In general, they are respected by the community, especially in rural areas, and can help guide and raise the population's awareness of preventive measures. The objective of this paper is to evaluate the results in knowledge progress of an e-learning course offered to educators and health assistants by a public university and to analyze the profile and satisfaction of the participants. MATERIALS AND METHODS A single group pre- and post-test design based on a questionnaire, interventional, study was conducted in the period from April 20th to June 20th. All participants of the course answered sociodemographic and satisfaction questionnaire and a pre- and post-test. Data were descriptively arranged and regarding the distribution and comparison of means and frequency, paired t-test for group comparisons. P < 0.05 was statistically significant. Data were collected from the Moodle® teaching platform, without identifying the participants. RESULTS A total of 674 participants were enrolled in the five groups, and 583 concluded the course (86.5%). The reasons for those who did not access the entire course (n = 47) were: Lack of time, difficulty in accessing the internet, and lack of experience with distance learning courses. On the evaluation of the course platform, from the tutors in general and the degree of satisfaction in several questions, participants marked maximum grades. The comparison between pre- and post-proficiency scores showed increased proficiency of the enrolled groups (P < 0.0001). CONCLUSIONS The course contributed to the training of health assistants and educators, preparing them to act in a participatory way in the prevention and control of the pandemic. The course was well evaluated and there was a progression of knowledge by the participants.
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Affiliation(s)
- Maria do Carmo Barros de Melo
- Department of Pediatrics, Member of Health Technology Center and Telehealth Center. Coordinator of Simulation Center, Faculty of Medicine at Universidade Federal de Minas Gerais, Brazil
| | - Priscila Menezes Ferri
- Department of Pediatrics, Subcoordinator of Simulation Cente, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Zilma Silveira Nogueira Reis
- Department of Obstetric Gynecology, Coordinator of Health Informatics Center, Faculty of Medicine, Belo Horizonte, Brazil
| | - Solange Cervinho Bicalho Godoy
- Department of Basic Nursing, Coordinator of Telehealth Center, Nursing School Teacher, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vitória Andrade Palmeira
- Medicine Student, Faculty of Medicine – Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Gabriel Rocha
- Medicine Student, Faculty of Medicine – Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosalia Morais Torres
- Department of Clinical Medicine, Member of Health Technology Center and Telehealth Center, Faculty of Medicine at Universidade Federal de Minas Gerais, Brazil
| | - Unaí Tupinambás
- Department of Clinical Medicine, Faculty of Medicine at Universidade Federal de Minas Gerais, Brazil
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