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Majumder MAA, Bharatha A, Kumar S, Chatterjee M, Gupta S, Harewood H, Singh K, Johnson WMS, Rajasundaram A, Dutta SB, Prasad SV, Rahman S, Kabir R, Parsa AD, Gaur U, Rabbi AMF, Krishnamurthy K, Mohammad S, Chode V, Haque M, Campbell MH. Self-reported side effects of COVID-19 vaccines among health professions students in India. PeerJ 2024; 12:e17083. [PMID: 38590705 PMCID: PMC11000642 DOI: 10.7717/peerj.17083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Studies focusing on the safety and common side effects of vaccines play a crucial role in enhancing public acceptance of vaccination. Research is scarce regarding the usage of COVID-19 vaccines and the side effects experienced by health professions students in India and other countries. This study aimed to document self-reported side effects associated with COVID-19 vaccination among medical and dental students of six medical and dental colleges and teaching hospitals in four states (Tamil Nadu, Madhya Pradesh, Gujarat, and West Bengal) of India. A cross-sectional survey using purposive sampling of medical and dental students was conducted from 26 April to 26 May 2021. Data was collected using a Google Forms questionnaire capturing information regarding receiving COVID-19 vaccines, side effects and symptoms, onset and duration of symptoms, use of treatment to alleviate symptoms, awareness of haematologic risks associated with vaccination, and side effects from previous (non-COVID-19) vaccinations. The majority (94.5%) of participants received both doses of the Covishield/AstraZeneca COVID-19 vaccine. Among participants (n = 492), 45.3% (n = 223) reported one or more side effects. The most frequently reported side effects were soreness of the injected arm (80.3%), tiredness (78.5%), fever (71.3%), headache (64.1%), and hypersomnia (58.7%). The two most common severe symptoms were fever (14.8%) and headache (13%). Most side effects appeared on the day of vaccination: soreness of the injection site (57%), fever (43.1%), and tiredness (42.6%). Most reported symptoms persisted for one to three days-soreness of the injection site (53%), fever (47.1%), and headache (42.6%). Logistic regression showed that women were almost 85% less likely to report side effects. The study's findings corroborate the safety of the Covishield/AstraZeneca vaccine's first dose, evidenced by the relatively minor and transient nature of the side effects. However, the study underscores the necessity for ongoing research to assess the long-term impacts of COVID-19 vaccines, especially in the context of booster doses, thereby contributing to the global understanding of vaccine safety and efficacy.
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Affiliation(s)
- Md Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
- Public Health Foundation of Bangladesh, Dhaka, Bangladesh
| | - Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | | | - Madhuri Chatterjee
- Shri Ramkrishna Institute of Medical Science, Durgapur, West Bengal, India
| | - Subir Gupta
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Heather Harewood
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Keerti Singh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - WMS Johnson
- Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | | | - Sudeshna Banerjee Dutta
- Department of Medical Surgical Nursing (Critical care nursing), Shri Anand Institute of Nursing, Rajkot, Gujarat, India
| | | | - Sayeeda Rahman
- American University of Integrative Sciences (AUIS), Bridgetown, Barbados
| | - Russell Kabir
- Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | | | - Uma Gaur
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | | | - Kandamaran Krishnamurthy
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Shegufta Mohammad
- Health Education Department, Empower Me First College, Geneva, Switzerland
| | | | - Mainul Haque
- National Defence University of Malaysia, Kuala Lumpur, Malaysia
| | - Michael H. Campbell
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
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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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Choi J, Ryu JG. COVID-19 vaccination intention among nursing, medical, and dental students: A systematic review and meta-regression analysis. Hum Vaccin Immunother 2023; 19:2253600. [PMID: 37732552 PMCID: PMC10515672 DOI: 10.1080/21645515.2023.2253600] [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: 06/08/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
The introduction of the COVID-19 vaccine amidst the pandemic has heralded a paradigm shift. Healthcare students in nursing, medicine, and dentistry must have positive attitudes owing to their future role in vaccine recommendations to the public and patients. This meta-regression analysis assessed the differences in COVID-19 vaccination intention (VI) of nursing, medical, and dental students. Medline/PubMed, EMBASE, CINAHL, Cochrane Library, and Korean MBASE were searched for eligible studies. Quality was assessed by the Joanna Briggs Institute's quality appraisal. Forty-one studies were included in the final analysis, and the estimation of pooled prevalence (68%) and relevant factors were assessed. Dental students were found to have the lowest VI (57%), which significantly (p = .018) differed from that of nursing students (64%). Countries in South-East Asia and those with high income levels were found to have high VI. Therefore, global vaccine programs for healthcare students should be prepared considering their geographical and economic status.
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Affiliation(s)
- Jongrim Choi
- College of Nursing, Keimyung University, Daegu, Republic of Korea
| | - Jae Geum Ryu
- College of Nursing, Chodang University, Muan, Republic of Korea
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Pourrazavi S, Fathifar Z, Sharma M, Allahverdipour H. COVID-19 vaccine hesitancy: A Systematic review of cognitive determinants. Health Promot Perspect 2023; 13:21-35. [PMID: 37309435 PMCID: PMC10257562 DOI: 10.34172/hpp.2023.03] [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: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 06/14/2023] Open
Abstract
Background: Although mass vaccination is considered one of the most effective public health strategies during the pandemic, in the COVID-19 era, many people considered vaccines unnecessary and, or doubted the effectiveness of the COVID-19 vaccine. This review aimed to tabulate cognitive causes of COVID-19 vaccination hesitancy, which may help public health policymakers overcome the barriers to mass vaccinations in future pandemics. Methods: For this systematic review, studies pertaining to COVID-19 vaccine hesitancy published up to June 2022 were retrieved from six online databases (Cochrane Library, Google Scholar Medline through PubMed, Scopus, and Web of Science). Inclusion criteria were the studies conducted on people who had a delay in accepting or refusing COVID-19 vaccines, reported the impact of cognitive determinants on vaccine hesitancy, and were written in English in the timeframe of 2020-2022. Results: This systematic review initially reviewed 1171 records. From these 91 articles met the inclusion criteria. The vaccination hesitation rate was 29.72% on average. This systematic review identified several cognitive determinants influencing vaccination hesitancy. Lack of confidence and complacency were the most frequent factors that predicted vaccine hesitancy. Conclusion: The identified prevailing cognitive determinants for COVID-19 vaccine hesitancy indicated that using initiative and effective communication strategies would be a determinant factor in building people's trust in vaccines during the pandemic and mass vaccinations.
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Affiliation(s)
- Sara Pourrazavi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Fathifar
- Department of Library, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Manoj Sharma
- Department of Social and Behavioral Health, University of Nevada, Las Vegas (UNLV), Las Vegas, NV 89119, USA
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89154, USA
| | - Hamid Allahverdipour
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
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Majumder MAA, Singh K, Johnson WMS, Rajasundaram A, Gupta S, Gaur U, Kumar S, Chatterjee M, Fazle Rabbi AM, Sangishetti VP, Rahman S, Campbell MH, Harewood H, Bharatha A, Krishnamurthy K, Kabir R, Parsa AD, Mohammmad S, Haque M, Razzaque MS. Evaluation of Short-Term Side Effects Following the First Dose of COVID-19 Vaccines Among Physicians and Dentists: A Cross-Sectional Study from India. J Multidiscip Healthc 2023; 16:161-174. [PMID: 36700174 PMCID: PMC9869700 DOI: 10.2147/jmdh.s390364] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
Background Efficacy and safety are fundamental for the development of successful COVID-19 vaccines. Vaccine-associated side effects influence vaccine hesitancy. This study investigated the prevalence, severity, and onset of side effects following the first dose of COVID-19 vaccines among physicians and dentists working in various healthcare settings across India. Methods A cross-sectional survey collected self-report data from April to June 2021 on side effects following the first dose of the vaccine. An online validated questionnaire using the Google Docs® platform was circulated via email and social media platforms. Results More than 40% of participants experienced at least one side effect after the first dose of vaccination; the most common were mild and resolved within three days after vaccination. More than 91% of respondents received the Covishield (AstraZeneca) vaccine; the most prevalent adverse effects were soreness of the injected arm (78.9%), tiredness (71.1%), and fever (54.9%). Logistic regression showed that women were almost 60% less likely to report side effects. Conclusion Findings supported the safety of the first dose of the COVID-19 vaccine based on relatively few self-limiting side effects, mainly soreness of the injected arm and tiredness. Further research is needed to determine the long-term safety of COVID-19 vaccines, especially after booster doses.
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Affiliation(s)
- Md Anwarul Azim Majumder
- Public Health Foundation of Bangladesh, Dhaka, Bangladesh,Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
| | - Keerti Singh
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
| | - W M S Johnson
- Department of Anatomy, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India,Correspondence: WMS Johnson, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India, Email ;
| | - Archana Rajasundaram
- Department of Anatomy, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Subir Gupta
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
| | - Uma Gaur
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
| | - Santosh Kumar
- Karnavati School of Dentistry, Karnavati University, Ahmedabad, Gujarat, India
| | - Madhuri Chatterjee
- Department of Pharmacology, Shri Ramkrishna Institute of Medical Science, Durgapur, West Bengal, India
| | | | | | - Sayeeda Rahman
- School of Medicine, American University of Integrative Sciences (AUIS), Bridgetown, Barbados
| | - Michael H Campbell
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
| | - Heather Harewood
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
| | - Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados
| | | | - Russell Kabir
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex, UK
| | - Ali Davod Parsa
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, Essex, UK
| | | | - Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, 57000, Malaysia,Mainul Haque, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia, Email ;
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Predictors of unwillingness to receive COVID -19 vaccines among Ethiopian Medical students. PLoS One 2022; 17:e0276857. [PMID: 36322591 PMCID: PMC9629586 DOI: 10.1371/journal.pone.0276857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 10/17/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Medical students are among the potential risky population for the transmission of COVID 19 infections; their willingness to receive COVID 19 vaccine is not well studied. Thus, this study assessed Predictors of Unwillingness to receive COVID -19 vaccines among Ethiopian Medical students. Methods From the 25th of May, 2020 to the 26th of June, 2021, an institution-based cross-sectional study was done at Mizan-Tepi University Teaching Hospital,On 313 medical students from each department and batch were chosen using a multistage sampling approach. A bivariate and multivariable logistic regression were done to identify the predictors of Unwillingness to receive COVID -19 vaccines. Figures, tables, and graphs were used to present the findings. The adjusted odds ratio and its 95% confidence interval were provided. Results In this study 124 (40.7%) 95% CI (35.1,46.4) medical students were not willing to receive the COVID-19 vaccine. And also increased in the age of the student[AOR 0.43, 95% CI; (.29,.63)], Knowledge status about COVID 19 infection transmission, risk factors and control behavior[AOR 1.45, 95% CI; (1.14, 1.85)], perceived susceptibility to COVID 19 infection [AOR 1.70 (1.15, 2.51)], perceived severity of COVID 19 infection[AOR 1.26 (1.01, 1.57)], perceived benefit of COVID 19 vaccine [AOR .58(.38, .88)], positive attitude towards COVID 19 vaccines [AOR .46(.35, .62)], and confidence in safety and efficacy of the vaccine and public authorities decissin in the best interest of the community [AOR 1.93(1.24, 2.99)] were predictors of non-willingness to receive COVID 19 vaccine. Conclusion Non-willingness to accept the COVID 19 vaccine was predicted by student age, elements in the Health belief model such as anticipated susceptibility, severity, and benefit, and a positive attitude and trust in the vaccine.
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Muacevic A, Adler JR. A Bibliometric Analysis of COVID-19 Scientific Literature From the English-Speaking Caribbean. Cureus 2022; 14:e30958. [PMID: 36465192 PMCID: PMC9713722 DOI: 10.7759/cureus.30958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 01/25/2023] Open
Abstract
The COVID-19 pandemic has led to a global crisis and has affected the Caribbean islands, leading to significant health and socioeconomic consequences in this region. Efforts to mitigate the burden of this disease have led to an accelerated amount of research in the English-speaking Caribbean (ESC). This bibliometric analysis aimed to evaluate the COVID-19-related scientific literature from the ESC nations. A total of 175 articles were included and analyzed from an initial PubMed search (n = 638) for COVID-19-related scientific literature from the ESC nations published between January 1, 2020, and June 30, 2022. Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington) and the VOSviewer (version 1.6.18) were used to characterize countries, authorship, journals, affiliations, and keywords of the COVID-19-related articles. Trinidad and Tobago (38%), Jamaica (22%), Barbados (20%), and Grenada (15%) contributed to the greatest number of publications. The University of the West Indies (UWI) campuses in Trinidad and Tobago, Jamaica and Barbados, and St. George's University in Grenada were the most prolific institutions. Srikanth Umakanthan from the UWI was the most prolific author. Cureus, SN Comprehensive Clinical Medicine, and Frontiers in Public Health were the first three most productive journals; 59% of the 175 articles had either the first or last author affiliated with an institution in the ESC, and 19% of the articles were country-focused: Trinidad and Tobago (16/175), Jamaica (9/175), Barbados (5/175), and Antigua and Barbuda (2/175). Among the top themes of research, 27% were outbreak response and rearrangements, epidemiological studies (23%), clinical management (23%), and medical education (13%). Over the last two years, an interest stimulated by the pandemic has expanded the research in ESC countries. However, gaps in the knowledge exist, especially in the epidemiology of COVID-19 complications in the sub-populations of chronic non-communicable diseases, post-COVID syndrome, and the long-COVID syndrome in the region. Hence, there is enormous scope for more research across the region.
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Maria S, Pelupessy DC, Koesnoe S, Yunihastuti E, Handayani DOTL, Siddiq TH, Mulyantini A, Halim ARV, Wahyuningsih ES, Widhani A, Awanis GS, Muda MG, Karjadi TH, Hasibuan AS, Rengganis I, Djauzi S. COVID-19 Booster Vaccine Intention by Health Care Workers in Jakarta, Indonesia: Using the Extended Model of Health Behavior Theories. Trop Med Infect Dis 2022; 7:tropicalmed7100323. [PMID: 36288064 PMCID: PMC9610584 DOI: 10.3390/tropicalmed7100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/29/2022] Open
Abstract
In Indonesia, COVID-19 vaccination hesitancy persists among health care workers (HCWs). Understanding the motives and challenges impacting HCWs’ acceptance of the booster vaccination is critical. Efforts are still needed to overcome apprehension about taking a booster dosage. This study aims to analyze the vaccine acceptance among HCWs in Jakarta using an extended, modified model of health behavior theories, namely The Health Belief Model (HBM) and The Theory of Planned Behavior (TPB). A cross-sectional survey from November 2021 to January 2022 was distributed to health care workers in Jakarta. Bivariate analysis followed by multivariate regression was used to assess factors associated with the vaccine intention and collected 1684 responses. The results have shown that the final model combining the constructs and demographic characteristics could explain 50% of the variance of intention to receive a COVID-19 booster vaccination. Moreover, anticipated regret had the most significant standardized coefficient among the constructs (β = 0.381, p < 0.001). Other significant predictors in the model were attitude (β = 0.243, p < 0.001), perceived benefits (β = 0.103, p < 0.001), subjective norms (β = 0.08, p = 0.005), and perceived susceptibility (β = 0.051, p = 0.016). The findings can be used to strategize interventions to increase vaccine uptake.
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Affiliation(s)
- Suzy Maria
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
- Correspondence: ; Tel.: +62-21-3141160
| | | | - Sukamto Koesnoe
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Evy Yunihastuti
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | | | - Tommy Hariman Siddiq
- Faculty of Psychology and Education, Universitas Al-Azhar Indonesia, Jakarta 12110, Indonesia
| | | | | | | | - Alvina Widhani
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Ghina Shabrina Awanis
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Maulana Girsang Muda
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Teguh Harjono Karjadi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Anshari Saifuddin Hasibuan
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Iris Rengganis
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
| | - Samsuridjal Djauzi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
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Bharatha A, Krishnamurthy K, Cohall D, Rahman S, Forde CA, Corbin-Harte R, Ojeh N, Kabir R, Parsa AD, Rabbi AMF, Majumder MAA. Personal protective equipment (PPE) related adverse skin reactions among healthcare workers at the main COVID-19 isolation center in Barbados. Front Public Health 2022; 10:978590. [PMID: 36304246 PMCID: PMC9592812 DOI: 10.3389/fpubh.2022.978590] [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: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
Background The use of personal protective equipment (PPE) reduces the risk of transmission of infectious agents significantly among healthcare workers (HCWs). The study aimed to investigate the prevalence and characteristics of PPE-related adverse skin reactions among HCWs working at the main COVID-19 isolation center in Barbados. Methods A cross-sectional web-based online survey was conducted during April to June 2021 which recorded demographic information, details of PPE use and adverse skin reactions including severity and duration of onset of symptoms. Results Most of the respondents used PPE for consecutive days (77.9%), 1-6 h/day (59.2%), and more than a year (62.5%). Fewer than half of the participants (45.6%) experienced adverse skin reactions from the use of PPE. The reactions were mostly observed in the cheeks (40.4%) and nose bridges (35.6%). Females had more reactions than their male counterparts (p = 0.003). The use of N95 masks and a combination of surgical and N95 masks produced adverse effects predominantly in the ears (60%) and cheeks (56.4%). Binary logistic regression showed that female HCWs (OR = 5.720 95% CI: 1.631, 20.063), doctors (OR = 5.215 95% CI: 0.877, 31.002), and longer duration of PPE use (>1 year) (OR = 2.902 95% CI: 0.958, 8.787) caused a significantly higher prevalence of adverse skin reactions. Conclusion The PPE-related skin reactions were common among HCWs which mainly occurred due to prolonged use. Preventive measures inclusive of appropriate training of HCWs on the use of PPE are recommended to minimize these adverse events.
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Affiliation(s)
- Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Kandamaran Krishnamurthy
- PICU Consultant, Queen Elizabeth Hospital, Bridgetown, Barbados,*Correspondence: Kandamaran Krishnamurthy
| | - Damian Cohall
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Sayeeda Rahman
- American University of Integrative Sciences, School of Medicine, Bridgetown, Barbados
| | - Corey A. Forde
- Infection Prevention and Control/Infectious Diseases Programs, The Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Rhea Corbin-Harte
- Isolation Facilities Client Relations and Activities, Bridgetown, Barbados
| | - Nkemcho Ojeh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Russell Kabir
- Faculty of Health Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Ali Davod Parsa
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
| | | | - Md Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
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10
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Koesnoe S, Siddiq TH, Pelupessy DC, Yunihastuti E, Awanis GS, Widhani A, Karjadi TH, Maria S, Hasibuan AS, Rengganis I, Djauzi S. Using Integrative Behavior Model to Predict COVID-19 Vaccination Intention among Health Care Workers in Indonesia: A Nationwide Survey. Vaccines (Basel) 2022; 10:719. [PMID: 35632476 PMCID: PMC9145718 DOI: 10.3390/vaccines10050719] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Health care workers (HCWs) are a high-priority group for COVID-19 vaccination for several reasons. Health behavior theory-based studies on the intention or acceptability of COVID-19 vaccination among Indonesian HCWs is lacking. Using an integrated behavioral model, this research sought to identify Indonesian health care workers' intentions to obtain COVID-19 vaccines. Methods: A countrywide cross-sectional questionnaire-based survey was conducted. The questionnaire was constructed on the basis of IBM (integrated behavioral model) constructs and scored on a seven-point bipolar scale. A hierarchical multivariable regression was used to evaluate the fit of the predictor model as well as the correlations between variables in the study. Results: 3304 people responded to the survey. A model combining demographic and IBM characteristics predicted 42.5 percent (adjusted R2 = 0.42) of the COVID-19 vaccination intention. Vaccination intention was associated with favorable vaccine attitudes, perceived norms, and self-efficacy. Among the determining constructs, behavior belief predicted vaccination intention the best. Being female, being married, having a history of COVID-19 infection, living outside Java Island, and having a low income were all linked to lower vaccination intentions. Conclusions: This study confirms the IBM model's robustness in predicting health care workers' intention to vaccinate against COVID-19.
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Affiliation(s)
- Sukamto Koesnoe
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.Y.); (G.S.A.); (A.W.); (T.H.K.); (S.M.); (A.S.H.); (I.R.); (S.D.)
| | - Tommy Hariman Siddiq
- Faculty of Psychology and Education, Universitas Al-Azhar Indonesia, Jakarta 12110, Indonesia;
| | - Dicky C. Pelupessy
- Faculty of Psychology and Education, Universitas Indonesia, Depok 16424, Indonesia;
| | - Evy Yunihastuti
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.Y.); (G.S.A.); (A.W.); (T.H.K.); (S.M.); (A.S.H.); (I.R.); (S.D.)
| | - Ghina Shabrina Awanis
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.Y.); (G.S.A.); (A.W.); (T.H.K.); (S.M.); (A.S.H.); (I.R.); (S.D.)
| | - Alvina Widhani
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.Y.); (G.S.A.); (A.W.); (T.H.K.); (S.M.); (A.S.H.); (I.R.); (S.D.)
| | - Teguh Harjono Karjadi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.Y.); (G.S.A.); (A.W.); (T.H.K.); (S.M.); (A.S.H.); (I.R.); (S.D.)
| | - Suzy Maria
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.Y.); (G.S.A.); (A.W.); (T.H.K.); (S.M.); (A.S.H.); (I.R.); (S.D.)
| | - Anshari Saifuddin Hasibuan
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.Y.); (G.S.A.); (A.W.); (T.H.K.); (S.M.); (A.S.H.); (I.R.); (S.D.)
| | - Iris Rengganis
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.Y.); (G.S.A.); (A.W.); (T.H.K.); (S.M.); (A.S.H.); (I.R.); (S.D.)
| | - Samsuridjal Djauzi
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (E.Y.); (G.S.A.); (A.W.); (T.H.K.); (S.M.); (A.S.H.); (I.R.); (S.D.)
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11
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Prevalence of COVID-19 Infection among Patients with Diabetes and Their Vaccination Coverage Status in Saudi Arabia: A Cross-Sectional Analysis from a Hospital-Based Diabetes Registry. Vaccines (Basel) 2022; 10:vaccines10020310. [PMID: 35214769 PMCID: PMC8878518 DOI: 10.3390/vaccines10020310] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 12/23/2022] Open
Abstract
Patients with diabetes have a higher risk of severe infection and mortality due to COVID-19. Considering the current limited effective pharmacological treatments, vaccination remains one of the most effective means to control the pandemic. The current study aimed to determine the prevalence of COVID-19 infection and the rate of COVID-19 vaccination coverage among patients with type 2 diabetes mellitus. The patients were identified from a diabetes hospital registry at Prince Sultan Military Medical City, Riyadh, Saudi Arabia in July 2021. The history of COVID-19 infection and the vaccination status were retrieved from the National Health Electronic Surveillance Network (HESN) program and the Seha platform, respectively. A total of 11,573 patients were included in this study (representing 99.5% of all patients in the registry). A total of 1981 patients (17.1%) had a history of confirmed COVID-19 infection. The rate of vaccination with a 1st dose was 84.8% (n = 9811), while the rate of full vaccination with the 2nd dose was 55.5% (n = 6422). The analysis showed that a higher proportion of male patients were fully vaccinated than female patients (61.0% versus 51.2%, p < 0.001). There were statistically significant differences among the age groups, with the full vaccination rate ranging from 59.0% for the 61–70-year-old age group to 49.0% for the > 80-year-old age group (p < 0.001). The patients with no previous history of COVID-19 infection were more likely to get fully vaccinated than those with a previous history of the infection (63.9% versus 14.6%, respectively, p < 0.001). The factors associated with a higher likelihood of unvaccinated status included the female gender (adjusted odds ratio (aOR) = 1.705 (95% confidence interval (CI): 1.528–1.902)), elderly patients in the age group of 61–70 (aOR (95% CI) = 1.390 (1.102–1.753)), the age group of 71–80 (aOR (95% CI) = 1.924 (1.499–2.470)) and the age group of >80 (aOR (95% CI) = 3.081 (2.252–4.214), and prior history of COVID-19 infection (aOR (95% CI) = 2.501 (2.223–2.813)). In conclusion, a considerable proportion of patients with type 2 diabetes had confirmed COVID-19 infection. Continued targeted efforts are needed to accelerate vaccination coverage rates among patients with diabetes in general and the particular subgroups identified in this study.
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Chi L, Zhao G, Chen N, Shen G, Huang K, Xia X, Chen Y, Liu J, Xu R, Chen Y, Dong W, Zheng J. Comparison of Predictors of COVID-19 Vaccination Intention Between Healthcare Workers and Non-Healthcare Workers in China. J Multidiscip Healthc 2022; 14:3597-3606. [PMID: 35002249 PMCID: PMC8722697 DOI: 10.2147/jmdh.s341326] [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: 10/22/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Vaccination is an effective strategy to mitigate the spread of COVID-19. This study aimed to compare predictors of vaccination intention between healthcare workers (HCWs) and non-healthcare workers (non-HCWs) in China. Methods A web-based cross-sectional survey was conducted among HCWs and non-HCWs. Several bivariate analysis techniques, eg, crosstab with Chi-square, independent t-test and single factor ANOVA, were performed to analyze the correlation. After that, a series of multivariate binary regressions were employed to determine predictors of vaccination intention. Results Intention was closely and significantly related with gender, perceived vaccination knowledge, perceived importance and effectiveness of vaccine to prevent COVID-19. HCWs and non-HCWs were heterogeneous, since vaccination intention, perceived knowledge, and attitudes (eg, importance, severity, risk) toward COVID-19 or vaccine had statistically significant difference between the two groups. With comparison of predictors of vaccination intention, for HCWs, demographic factors were the major predictors of COVID-19 vaccination intention. Female HCWs and HCWs with a Master’s or higher degree were more hesitant about vaccination (P = 0.01 and P < 0.001, respectively), while HCWs had greater vaccination intention as their age increased (P = 0.02). For non-HCWs, perceived vaccination knowledge was the major predictor of COVID-19 vaccination intention (P < 0.001). Additionally, perceived importance and effectiveness of vaccine were predictors for both HCWs and non-HCWs. Conclusion Vaccination intention of HCWs was greater than that of non-HCWs in China. Measures should be taken to improve the vaccination rate based on the predictors of vaccination intention identified in this study. For HCWs, especially those with a high level of education or who were females, the safety and effectiveness of vaccines in use may reinforce their vaccination intention. For non-HCWs, popularization of general medical knowledge, including of vaccine-preventable diseases, may increase their vaccination intention.
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Affiliation(s)
- Lisha Chi
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Guojing Zhao
- Institute of China Innovation and Entrepreneurship Education, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Naiche Chen
- Renji College, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Guanghui Shen
- School of Mental Health, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Kai Huang
- School of Mental Health, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Xiaoyu Xia
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yijing Chen
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jian Liu
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ran Xu
- Department of Natural Science, Affiliated School of Wenzhou University Town, Wenzhou, People's Republic of China
| | - Yanhan Chen
- School of Stomatology, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Weijie Dong
- The 1th School of Medicine, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jiexia Zheng
- Department of Student Affairs, Wenzhou Medical University, Wenzhou, People's Republic of China
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13
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Transcranial magnetic stimulation in the treatment of adolescent depression: a systematic review and meta-analysis of aggregated and individual-patient data from uncontrolled studies. Eur Child Adolesc Psychiatry 2022; 31:1501-1525. [PMID: 35751003 PMCID: PMC9532325 DOI: 10.1007/s00787-022-02021-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/01/2022] [Indexed: 12/31/2022]
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive treatment for adolescent major depressive disorder (MDD). Existing evidence on the efficacy of TMS in adolescent MDD awaits quantitative synthesis. A systematic literature search was conducted, and data from eligible studies were synthesized using random-effects models. Treatment-covariate interactions were examined in exploratory analyses of individual-patient data (IPD). Systematic search of the literature yielded 1264 hits, of which 10 individual studies (2 randomized trials) were included for quantitative synthesis of mainly uncontrolled studies. Individual patient data (IPD) were available from five trials (all uncontrolled studies). Quantitative synthesis of aggregated data revealed a statistically significant negative overall standardized mean change (pooled SMCC = 2.04, 95% CI [1.46; 2.61], SE = 0.29, p < .001), as well as a significant overall treatment response rate (Transformed Proportion = 41.30%, 95% CI [31.03; 51.57], SE = 0.05; p < 0.001), considering data from baseline to post-treatment. Exploratory IPD analyses suggests TMS might be more effective in younger individuals and individuals with more severe depression, and efficacy might be enhanced with certain treatment modality settings, including higher number of TMS sessions, longer treatment durations, and unilateral and not bilateral stimulation. Existing studies exhibit methodological shortcomings, including small-study effects and lack of control group, blinding, and randomization-compromising the credibility of the present results. To date, two randomized controlled trials on TMS in adolescent depression have been published, and the only large-scale randomized trial suggests TMS is not more effective than sham stimulation. Future large-scale, randomized, and sham-controlled trials are warranted. Future trials should ensure appropriate selection of patients for TMS treatment and guide precision medicine approaches for stimulation protocols.
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Krishnamurthy K, Sobers N, Kumar A, Ojeh N, Scott A, Cave C, Gupta S, Bradford-King J, Sa B, Adams OP, Campbell MH, Majumder MAA. COVID-19 Vaccine Intent Among Health Care Professionals of Queen Elizabeth Hospital, Barbados. J Multidiscip Healthc 2021; 14:3309-3319. [PMID: 34876817 PMCID: PMC8643144 DOI: 10.2147/jmdh.s336952] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/17/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Due to increased exposure risk and the potential impact of COVID-19 infection, health care professionals (HCP) are a target group for COVID-19 vaccination. This study aimed to examine the acceptability of COVID-19 vaccines among HCP at the Queen Elizabeth Hospital, Barbados. DESIGN AND METHODS A cross-sectional survey of HCP was conducted between February 14 and 27, 2021 using an online questionnaire. The questionnaire included demographic information, knowledge of novel coronavirus, intention to accept the COVID-19 vaccination, vaccine literacy (VL), and perceptions and attitudes regarding COVID-19 vaccines. Mean VL scores were calculated. The relationship between socio-demographic variables and vaccine intent was assessed using a multivariable logistic regression model. RESULTS Of 343 HCPs, 55.1% indicated they would accept the COVID-19 vaccine if it were available; 44.9% expressed hesitancy towards the COVID-19 vaccine. We assessed the impact of socio-demographic factors and previous vaccine behavior on vaccine intent; after adjustment of the multivariable logistic regression model, non-Barbadian nationality and previous flu vaccine uptake were statistically significant predictors of reported intent to take the COVID-19 vaccine. Persons who indicated that they would take the vaccine had a higher mean vaccine literacy score [3.46 95% CI (3.40, 3.52)] than those who were not ready to take the vaccine immediately [3.23 95% CI (3.15, 3.30)]. VL scores were higher among the 29.5% of HCPs who believed vaccines should be mandatory. CONCLUSION This study highlighted vaccine hesitancy among HCPs in the sole public tertiary hospital of Barbados. As HCP perceptions may help or hinder the campaign to promote vaccine uptake in Barbados, vaccine promotion programs targeting HCPs are needed to ensure the success of the country's COVID-19 vaccination drive.
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Affiliation(s)
- Kandamaran Krishnamurthy
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Natasha Sobers
- Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Alok Kumar
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Nkemcho Ojeh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Andrea Scott
- The Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Clyde Cave
- The Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Subir Gupta
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | | | - Bidyadhar Sa
- Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Oswald Peter Adams
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Michael H Campbell
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Md Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
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