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Ghassemi EY, Thorseth AH, Le Roch K, Heath T, White S. Mapping the association between mental health and people's perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review. PLoS One 2023; 18:e0286494. [PMID: 38096240 PMCID: PMC10721104 DOI: 10.1371/journal.pone.0286494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people's perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.
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Affiliation(s)
- Emily Yasmin Ghassemi
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Astrid Hasund Thorseth
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Sian White
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Kalam MA, Al Asif CA, Hasan MM, Arif-Ur-Rahman M, Nag DK, Sen PK, Haque Akhanda MA, Davis TP, Talukder A. Understanding the behavioral determinants that predict barriers and enablers of screening and treatment behaviors for diabetic retinopathy among Bangladeshi women: findings from a barrier analysis. BMC Public Health 2023; 23:1667. [PMID: 37648981 PMCID: PMC10466885 DOI: 10.1186/s12889-023-16106-8] [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: 01/06/2023] [Accepted: 06/12/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND AND AIM While early detection and timely treatments can prevent diabetic retinopathy (DR) related blindness, barriers to receiving these DR services may cause permanent sight loss. Despite having similar prevalence to diabetes and DR, women are less likely than men to perform these behaviors due to multi-faced barriers in screening and receiving follow-up treatments for DR. This study, therefore, aimed at identifying the barriers to - and enablers of - screening and follow-up treatments behaviors for DR among women aged more than 40 years with diabetes from the behavioral perspectives in Bangladesh. METHODS This Barrier Analysis study interviewed 360 women (180 "Doers" and 180 "Non-doers") to explore twelve behavioral determinants of four DR behaviors including screening, injection of anti-vascular endothelial growth factor (anti-VEGF medication), laser therapy and vitro-retinal surgery. The data analysis was performed to calculate estimated relative risk to identify the degree of association between the determinants and behaviors, and to find statistically significant differences (at p < 0.05) in the responses between the Doers and Non-doers. RESULTS Access to healthcare facilities was the major barrier impeding women from performing DR behaviors. Difficulty in locating DR service centers, the need to travel long distances, the inability to travel alone and during illness, challenges of paying for transportation and managing workload significantly affected women's ability to perform the behaviors. Other determinants included women's perceived self-efficacy, perceived negative consequences (e.g. fear and discomfort associated with injections or laser treatment), and cues for action. Significant perceived enablers included low cost of DR treatments, supportive attitudes by healthcare providers, government policy, and perceived social norms. CONCLUSION The study found a host of determinants related to the barriers to and enablers of DR screening and treatment behaviors. These determinants included perceived self-efficacy (and agency), positive and negative consequences, perceived access, perceived social norms, culture, and perceived risk. Further investments are required to enhance the availability of DR services within primary and secondary health institutions along with health behavior promotion to dispel misconceptions and fears related to DR treatments.
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Affiliation(s)
- Md Abul Kalam
- Global Health and Development Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh.
| | - Chowdhury Abdullah Al Asif
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh
- Save the Children International, Bangladesh Country Office, Dhaka, Bangladesh
| | - Md Mehedi Hasan
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh.
| | - Md Arif-Ur-Rahman
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh
| | - Dipak Kumar Nag
- National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh
| | - Pallab Kumar Sen
- Shaheed Ziaur Rahman Medical College (SZMC), Silimpur, Bogura, 5800, Bangladesh
| | - Md Aminul Haque Akhanda
- Mymensingh Medical College and Hospital, Chorpara Mymensingh, 2200, Bangladesh
- Community Based Medical College Bangladesh (CBMCB), Winnerpar, Mymensingh, 2200, Bangladesh
| | - Thomas P Davis
- Global Alliance for Vaccine and Immunization, Geneva, Switzerland
| | - Aminuzzaman Talukder
- Helen Keller International, Bangladesh Country Office, House: 10/E, Road: 82, Gulshan-2, Dhaka, 1212, Bangladesh
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Ali AS, Yohannes MW, Tesfahun T. Hygiene Behavior and COVID-19 Pandemic: Opportunities of COVID-19-Imposed Changes in Hygiene Behavior. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231218421. [PMID: 38140893 DOI: 10.1177/00469580231218421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
In Ethiopia, the WHO strategies to stop coronavirus transmission were implemented rapidly. As a result, there was a rapid change in hygiene behavior, which are basic for preventing COVID-19 and other contagious diseases. This research was designed to examine the sustainability of the COVID-19 imposed hygiene behaviors for future challenges. The study was conducted in 2 major nexus areas in Addis Ababa. The data were collected using a questionnaire and spot-check from 622 respondents selected by systematic random sampling. The questionnaire was given at every 15th interval in several spots of the site. Observational hygiene-check was done through observing key personal hygiene conditions. Proportion, χ2 test, and Poisson's regression were applied for the analysis. The χ2-test analyses showed that the hand washing frequency before, during, and post-COVID-19 was statistically significant (P < .005). Findings from the spot-check also show that the hands of 76.8%, the nails of 68.7%, and the hairs of 70.7% of the respondents were clean. The major driving factors for the rapid changes in hygiene behavior were the awareness developed (95%), the fear and panic (90%), and increased access to water and soap (63%). Nevertheless, the major reasons for failing to continue the COVID-19-imposed good hygiene practice in the post-COVID-19 times include the decline in infection and death rates (26%) and the decline in facility access (20%). Hand washing frequency significantly changed during the COVID-19 pandemic indicating that the practice as part of the preventive strategy was successful. However, as this was mainly due to the fear and panic in the community, the COVID-19 imposed hand washing practice did not bring real and sustainable behavioral changes. This indicates that for long-lasting changes in hygiene behavior, continuous and better approach need to be introduced.
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White S, Jain A, Bangura A, Farrington M, Mekonen M, Nhial BC, Hoque E, Moniruzzaman M, Namegabe P, Walassa J, Majorin F. Facilitating hand hygiene in displacement camps during the COVID-19 pandemic: a qualitative assessment of a novel handwashing stand and hygiene promotion package. Confl Health 2022; 16:65. [PMID: 36527055 PMCID: PMC9756724 DOI: 10.1186/s13031-022-00492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Handwashing with soap is critical for the prevention of diarrhoeal diseases and outbreak related diseases, including interrupting the transmission of COVID-19. People living in large displacement settings are particularly vulnerable to such outbreaks, however, practicing handwashing is typically challenging in these contexts. METHODS We conducted a qualitative assessment of the implementation of a combined intervention to facilitate handwashing behaviour in displacement camps and in surrounding communities in Bangladesh, Ethiopia and the Democratic Republic of Congo during the COVID-19 pandemic. The intervention comprised a 'hardware' infrastructural component (provision of the Oxfam Handwashing Station) and a 'software' hygiene promotion package (Mum's Magic Hands). We used programmatic logbooks, interviews with implementation staff and focus group discussions with crisis-affected populations to assess the use, feasibility and acceptability of the intervention. RESULTS Both components of the intervention were viewed as novel and appealing by implementing staff and crisis-affected populations across the study sites. The acceptability of the handwashing station could be improved by redesigning the tap and legs, exploring local supply chain options, and by providing a greater number of facilities. The implementation of the hygiene promotion package varied substantially by country making it challenging to evaluate and compare. A greater focus on community engagement could address misconceptions, barriers related to the intuitiveness of the handwashing station design, and willingness to participate in the hygiene promotion component. CONCLUSIONS The combination of a 'hardware' and 'software' intervention in these settings appeared to facilitate both access and use of handwashing facilities. The acceptability of the combined intervention was partially because a great deal of effort had been put into their design. However, even when delivering well-designed interventions, there are many contextual aspects that need to be considered, as well as unintended consequences which can affect the acceptability of an intervention.
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Affiliation(s)
- Sian White
- grid.8991.90000 0004 0425 469XDepartment of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | | | - Abie Bangura
- grid.437028.a0000 0004 0450 9859Oxfam, John Smith Drive, Oxford, UK
| | | | | | - Bang Chuol Nhial
- Department of Public Health, Gambella University, Gambella Town, Gambella, Ethiopia
| | - Enamul Hoque
- Oxfam in Bangladesh, RAOWA Complex, VIP Road, Dhaka, 1206 Bangladesh
| | - Md. Moniruzzaman
- Oxfam in Bangladesh, RAOWA Complex, VIP Road, Dhaka, 1206 Bangladesh
| | | | - John Walassa
- Oxfam in DRC, Goma, Democratic Republic of Congo
| | - Fiona Majorin
- grid.8991.90000 0004 0425 469XDepartment of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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White S, Heath T, Khalid Ibrahim W, Ihsan D, Blanchet K, Curtis V, Dreibelbis R. How is hygiene behaviour affected by conflict and displacement? A qualitative case study in Northern Iraq. PLoS One 2022; 17:e0264434. [PMID: 35239702 PMCID: PMC8893612 DOI: 10.1371/journal.pone.0264434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 02/10/2022] [Indexed: 12/30/2022] Open
Abstract
This research aimed to qualitatively explore whether the determinants of handwashing behaviour change according to the duration of displacement or the type of setting that people are displaced to. We conducted an exploratory qualitative study in three different post-conflict settings in Northern Iraq–a long-term displacement camp, a short-term displacement camp, and villages where people were returning to post the conflict. We identified 33 determinants of handwashing in these settings and, of these, 21 appeared to be altered by the conflict and displacement. Determinants of handwashing behaviour in the post-conflict period were predominantly explained by disruptions to the physical, psychological, social and economic circumstances of displaced populations. Future hygiene programmes in post-conflict displacement settings should adopt a holistic way of assessing determinants and design programmes which promote agency, build on adaptive norms, create an enabling environment and which are integrated with other aspects of humanitarian response.
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Affiliation(s)
- Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Thomas Heath
- Operations Department, Action Contre la Faim, Paris, France
| | - Waleed Khalid Ibrahim
- Independent Researcher, Nutrition and Dietetics Department, College of Medical Technology, Cihan University, Erbil, Kurdistan Region of Iraq
| | - Dilveen Ihsan
- Independent Researcher, Dohuk, Kurdistan Region of Iraq
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Université de Genève, Geneva, Switzerland
| | - Val Curtis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Davis TP, Yimam AK, Kalam MA, Tolossa AD, Kanwagi R, Bauler S, Kulathungam L, Larson H. Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries. Vaccines (Basel) 2022; 10:vaccines10020214. [PMID: 35214672 PMCID: PMC8875839 DOI: 10.3390/vaccines10020214] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal. This study aimed to identify the behavioural determinants of COVID-19-vaccine acceptance and provide recommendations to design actionable interventions to increase uptake of the COVID-19 vaccine in six lower- and middle-income countries. Taking into consideration the health belief model and the theory of reasoned action, a barrier analysis approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo (DRC), and Tanzania. In all six countries, at least 45 interviews with those who intended to get the vaccine (“Acceptors”) and another 45 or more interviews with those who did not (“Non-acceptors”) were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (p < 0.05) differences between Acceptors and Non-acceptors of COVID-19 vaccines and to identify which beliefs were most highly associated with acceptance and non-acceptance of vaccination based on the estimated relative risk. The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk, perceived severity, trust, perceived safety, and expected access to COVID-19 vaccines had the highest associations with COVID-19-vaccine acceptance in Bangladesh, Kenya, Tanzania, and the DRC. Additional behavioural determinants found to be significant in Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. Many of the determinants were found to be significant, and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study to significantly increase the uptake of COVID-19 vaccines across these countries.
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Affiliation(s)
- Thomas P. Davis
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
- Correspondence: ; Tel.: +41-79-692-4053
| | - Adugna Kebede Yimam
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
| | - Md Abul Kalam
- Bangladesh Country Office, Helen Keller International, Dhaka 1212, Bangladesh;
| | | | - Robert Kanwagi
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
| | - Sarah Bauler
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
| | - Loria Kulathungam
- World Vision International, 1202 Geneva, Switzerland; (A.K.Y.); (R.K.); (S.B.); (L.K.)
| | - Heidi Larson
- Vaccine Confidence Project, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
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Barrier analysis for adequate daily fruit and vegetable consumption among low-income residents of Hanoi, Vietnam and Ibadan, Nigeria. GLOBAL FOOD SECURITY 2021. [DOI: 10.1016/j.gfs.2021.100586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Amuakwa-Mensah F, Klege RA, Adom PK, Köhlin G. COVID-19 and handwashing: Implications for water use in Sub-Saharan Africa. WATER RESOURCES AND ECONOMICS 2021; 36:100189. [PMID: 34745865 PMCID: PMC8563594 DOI: 10.1016/j.wre.2021.100189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/27/2021] [Accepted: 10/28/2021] [Indexed: 05/21/2023]
Abstract
Because the main modes of transmission of the COVID-19 virus are respiration and contact, WHO recommends frequent washing of hands with soap under running water for at least 20 s. This article investigates how the level of concern about COVID-19 affects the likelihood of washing hands frequently in sub-Saharan Africa. We discuss the implication of the findings for water-scarce environment. The study makes use of a unique survey dataset from 12 sub-Saharan African countries collected in April 2020 (first round) and May 2020 (second round) and employs an extended ordered probit model with endogenous covariate. The results show that the level of concern about the spread of the virus increases the likelihood of washing hands with soap under running water for a minimum of 20 s at least five times a day. The increase in the probability of handwashing due to concern about COVID-19, ranges from 3% for Benin to 6.3% for South Africa. The results also show heterogeneous effects across gender- and age-groups, locality and various water sources. However, in Africa, the sustainability of the handwashing protocol could be threatened by the severe water scarcity that exists in the region. To sustain frequent handwashing, sub-Saharan Africa needs an effective strategy for water management and supply.
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Affiliation(s)
- Franklin Amuakwa-Mensah
- Environment for Development, University of Gothenburg, Box 645, SE 405 30, Göteborg, Sweden
- Department of Business Administration, Technology and Social Sciences, Luleå University of Technology, 971 87, Luleå, Sweden
| | - Rebecca Afua Klege
- School of Economics, University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa
- Henry J Austin Health Center, 321 N. Warren Street, Trenton, 08618, New Jersey, USA
| | - Philip Kofi Adom
- Department of Development Policy School of Public Service, Governance Ghana Institute of Management and Public Administration GIMPA, Ghana
| | - Gunnar Köhlin
- Environment for Development, University of Gothenburg, Box 645, SE 405 30, Göteborg, Sweden
- School of Economics, University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa
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Kalam MA, Davis TP, Shano S, Uddin MN, Islam MA, Kanwagi R, Islam A, Hassan MM, Larson HJ. Exploring the behavioral determinants of COVID-19 vaccine acceptance among an urban population in Bangladesh: Implications for behavior change interventions. PLoS One 2021; 16:e0256496. [PMID: 34424913 PMCID: PMC8382171 DOI: 10.1371/journal.pone.0256496] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/06/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND While vaccines ensure individual protection against COVID-19 infection, delay in receipt or refusal of vaccines will have both individual and community impacts. The behavioral factors of vaccine hesitancy or refusal are a crucial dimension that need to be understood in order to design appropriate interventions. The aim of this study was to explore the behavioral determinants of COVID-19 vaccine acceptance and to provide recommendations to increase the acceptance and uptake of COVID-19 vaccines in Bangladesh. METHODS We employed a Barrier Analysis (BA) approach to examine twelve potential behavioral determinants (drawn from the Health Belief Model [HBM] and Theory of Reasoned Action [TRA]) of intended vaccine acceptance. We conducted 45 interviews with those who intended to take the vaccine (Acceptors) and another 45 interviews with those who did not have that intention (Non-acceptors). We performed data analysis to find statistically significant differences and to identify which beliefs were most highly associated with acceptance and non-acceptance with COVID-19 vaccines. RESULTS The behavioral determinants associated with COVID-19 vaccine acceptance in Dhaka included perceived social norms, perceived safety of COVID-19 vaccines and trust in them, perceived risk/susceptibility, perceived self-efficacy, perceived positive and negative consequences, perceived action efficacy, perceived severity of COVID-19, access, and perceived divine will. In line with the HBM, beliefs about the disease itself were highly predictive of vaccine acceptance, and some of the strongest statistically-significant (p<0.001) predictors of vaccine acceptance in this population are beliefs around both injunctive and descriptive social norms. Specifically, Acceptors were 3.2 times more likely to say they would be very likely to get a COVID-19 vaccine if a doctor or nurse recommended it, twice as likely to say that most people they know will get a vaccine, and 1.3 times more likely to say that most close family and friends will get a vaccine. The perceived safety of vaccines was found to be important since Non-acceptors were 1.8 times more likely to say that COVID-19 vaccines are "not safe at all". Beliefs about one's risk of getting COVID-19 disease and the severity of it were predictive of being a vaccine acceptor: Acceptors were 1.4 times more likely to say that it was very likely that someone in their household would get COVID-19, 1.3 times more likely to say that they were very concerned about getting COVID-19, and 1.3 times more likely to say that it would be very serious if someone in their household contracted COVID-19. Other responses of Acceptors on what makes immunization easier may be helpful in programming to boost acceptance, such as providing vaccination through government health facilities, schools, and kiosks, and having vaccinators maintain proper COVID-19 health and safety protocols. CONCLUSION An effective behavior change strategy for COVID-19 vaccines uptake will need to address multiple beliefs and behavioral determinants, reducing barriers and leveraging enablers identified in this study. National plans for promoting COVID-19 vaccination should address the barriers, enablers, and behavioral determinants found in this study in order to maximize the impact on COVID-19 vaccination acceptance.
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Affiliation(s)
- Md. Abul Kalam
- Bangladesh Country Office, Helen Keller International, Dhaka, Bangladesh
| | | | - Shahanaj Shano
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
- EcoHealth Alliance, New York, New York, United States of America
| | - Md. Nasir Uddin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Md. Ariful Islam
- Bangladesh Country Office, SNV Netherlands Development Organisation, Dhaka, Bangladesh
| | | | - Ariful Islam
- EcoHealth Alliance, New York, New York, United States of America
| | | | - Heidi J. Larson
- Vaccine Confidence Project, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
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