Unpacking COVID-19 Vaccine Attitudes: Exploring Hesitancy and Acceptance Among Undergraduate Students in Bangladesh

BACKGROUND

Vaccine hesitancy is a significant global health concern, and mass vaccination is essential in preventing the spread of COVID-19. Undergraduate students need to be prioritized for vaccination as they continue their academic curriculum physically. However, limited research explores vaccine hesitancy and acceptance among undergraduate students in Bangladesh. Therefore, this study evaluated vaccine hesitancy and acceptance among this population.

METHOD

A web-based cross-sectional study was conducted between May and June 2021 using a structured questionnaire to assess COVID-19 vaccine hesitancy and acceptance among undergraduate students in Bangladesh. The Oxford Covid-19 Vaccine Hesitancy Scale was used to measure vaccine hesitancy. The study used convenient sampling.

RESULT

Across the country, 334 undergraduate students participated in this study on COVID-19 vaccine acceptance, with a mean age of 22.4 years. Most participants were male and unmarried, most having spent four years at university. 89.52% of participants would accept a COVID-19 vaccine if it were suggested by educational institutions or available, while 4.49% refused to receive the COVID-19 vaccine. Participants showed low levels of vaccine hesitancy, with a mean score of 10.77 on the Oxford COVID-19 Vaccine Hesitancy Scale. Most participants had a positive attitude towards receiving the vaccine, with the majority wanting to get it as soon as it becomes available. No association was found between vaccine acceptance and participants' background characteristics.

CONCLUSION

Our study found a high level of vaccine acceptance among undergraduate students in Bangladesh, indicating that this group can be vaccinated quickly, significantly accelerating vaccination goals. However, further large-scale studies are recommended among vulnerable groups, including school and college students, to ensure vaccine preparedness.

Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox's Bazar, Bangladesh

INTRODUCTION

Immunization campaigns and Expanded Program on Immunization (EPI) were launched by Government of Bangladesh (GoB) in collaboration with WHO and other Non-governmental Organizations (NGOs) to tackle the increased risk of vaccine preventable disease outbreak in the Rohingya refugee camps. Immunization coverage was found to be lower than expected. However, a few studies explored the factors behind low vaccine uptake among Refugee children. Therefore, this study was aimed.

METHODS

A cross sectional study was carried out among Rohingya parents living in registered camps and makeshift settlements located in Teknaf and Ukhiya upazilla of Cox's Bazar, Bangladesh. A total of 224 Rohingya parents were conveniently selected (122 parents from each type of camps). Data was collected using a pretested interviewer-administered semi-structured questionnaire with the help of bilingual volunteers who understand Rohingya dialect. All statistical analyses were carried out in IBM SPSS Version 26 (New York, USA).

RESULTS

Total 63.1% of Rohingya parents had good practice regarding childhood immunization (completed EPI vaccination) as per schedule. Of all, 74.6% had good knowledge and 94.7% had positive attitude towards EPI vaccination. Good practice regarding vaccination was significantly more common among parents living in registered camps (77%) than those living in makeshift settlements (49.2%, p<0.001). Multivariable logistic regression analysis revealed that living in registered camps (Adjusted Odds Ratio [aOR]: 2.99; 95% Confidence Interval [CI]: 1.41-6.32) and good knowledge level (aOR: 2.88; 95%CI: 1.32-15.82) were independent determinants of good practice. A separate analysis in both type of camps revealed that in registered camps, good knowledge level (aOR: 3.62; 95%CI: 1.45-9.04) and having >2 children (aOR: 3.71; 95%CI: 1.34-10.27), and in makeshift settlements, father's employment (aOR: 2.33; 95%CI: 1.34-6.72), father's education (aOR: 3.00; 95%CI: 1.34-6.72) and presence of any electronic device (e.g., radio, television, mobile phone) (aOR: 4.01; 95%CI: 0.96-16.84) were significant determinants of good childhood immunization practice.

CONCLUSION

Health education and promotion strategies should be implemented to increase knowledge and awareness about EPI immunization benefits among Rohingya parents to ensure greater coverage.

Factors associated with in-hospital mortality of adult tetanus patients–a multicenter study from Bangladesh

Background

Tetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh.

Methods

This prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. Kaplan Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analysis was done using Stata (version 16) and SPSS (version 26).

Results

A total of 61 tetanus cases were included, and the overall in-hospital mortality rate was 34.4% (n = 21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, age (adjusted hazard ratio [aHR] 4.03, 95% Confidence Interval [CI] 1.07–15.17, p = 0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05–10.57, p = 0.041) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications.

Conclusion

Older age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care.

Individual and Occupational Factors Associated With Low Back Pain: The First-ever Occupational Health Study Among Bangladeshi Online Professionals

Objectives

Low back pain (LBP) is a common chronic condition among sedentary workers that causes long-term productivity loss. This study aimed to identify the relationships of individual and occupational factors with LBP among Bangladeshi online professionals.

Methods

We conducted a cross-sectional study involving 468 full-time online professionals who usually worked in a sitting position. One-month LBP complaints were assessed using a musculoskeletal subscale of subjective health complaints. The chi-square test was used to measure associations between categorical predictors and LBP, and multivariable logistic regression was conducted to identify the variables significantly associated with LBP.

Results

LBP within the last month was reported by 65.6% of participants. Multivariable logistic regression analysis indicated that age >30 years (adjusted odds ratio [aOR], 0.40; 95% confidence interval [CI], 0.23 to 0.70) and being married (aOR, 0.59; 95% CI, 0.36 to 0.97) had significant negative associations with LBP. Significant positive associations were found for spending >50 hours weekly on average working in a sitting position (aOR, 1.61; 95% CI, 1.05 to 2.49), being overweight and obese (aOR, 1.87; 95% CI, 1.16 to 2.99), sleeping on a soft mattress (aOR, 2.01; 95% CI, 1.06 to 3.80), and ex-smoking status (aOR, 3.33; 95% CI, 1.41 to 7.87).

Conclusions

A high prevalence of LBP was found among full-time online professionals. Long working hours in a sitting position showed a significant association with developing LBP. Smoking history, body mass index, and sleeping arrangements should also be considered while considering solutions for LBP prevalence among online professionals.

Assessment of Depression and Anxiety Among Admitted People With Heart Disease Conditions: A Cross-Sectional Hospital-Based Study in a Bangladeshi Population During the COVID-19

OBJECTIVE

Depression and anxiety are widespread and chronic among patients with heart disease. We wanted to determine the proportion of heart patients with depression and anxiety levels as well as factors contributing toward depression and anxiety among hospitalized heart disease patients in Dhaka, Bangladesh during the COVID-19 era.

METHODS

The study comprised a total of 384 participants with a confirmed heart disease diagnosis. We conducted a cross-sectional study from 5th March to 27th June 2021. The hospital-based study admitted patients sequentially with a new or pre-existing heart disease diagnosis to one of Dhaka's two leading hospitals. The Hospital Anxiety and Depression Scale screened all individuals for depression and anxiety.

RESULT

Most of the respondents (88.2%) were male and within the age categories of 51-60 years (32.81%). 96.6% of the patients were married, 30% had no income, 36.6% had only completed classes 1-5, and ~47% resided in rural areas. Approximately 36% of the study participants were former smokers, with 31% current smokers. Borderline abnormal and abnormal levels of anxiety and borderline abnormal and abnormal levels of depression were found in (23.9%, 49.4%) and (55.7%, 13.3%), respectively, of hospitalized patients. Age, residence, profession, monthly income, and chronic disease were significant predictors of anxiety, while only gender remained significantly associated with depression.

CONCLUSION

Hospitalized Bangladeshi patients with heart disease had moderate levels of depression and anxiety. There is a need to develop a quick screening approach in hospitals dealing with hospitalized patients with heart disease to identify those needing extra evaluation and care.

SAT-015 Incidence and Predictors of Hypertension in a Cohort of Australian Women with and Without Polycystic Ovary Syndrome

Background: There is a lack of longitudinal studies exploring the relationships between polycystic ovary syndrome (PCOS) and hypertension, in population-based settings.

Objectives: To identify predictors of hypertension in women with and without PCOS and the relationship to body mass of index (BMI).

Methods: We undertook a community-based cohort analysis of the Australian Longitudinal Study (ALSWH) data conducted on 9,688 young adult women, aged 21–42 years from 2000–2015. We conducted survival analysis using the Cox Proportional Hazards Model to identify predictors and person-time analysis to calculate incidence rates of hypertension.

Results: Overall, 9,508 women were followed for 145,159 PY (person-years) and 1,556 (16.37%) women developed hypertension during the follow-up. The incidence of hypertension was significantly higher (p = 0.001) among women with PCOS (17/1000 PY) compared to women without (11/1000 PY). There were significant differences in time to hypertension development between women +/- PCOS. Hypertension was observed among women with PCOS from early adulthood and across BMI categories. The difference in the actual number of incident hypertension cases (incidence rate difference (IRD)) between women with and without PCOS, was fourfold higher (15.8 vs. 4.3 respectively) among women who were obese at baseline, compared to age-matched lean women. PCOS was independently associated with hypertension with a 36% greater risk, adjusting for BMI and other confounders.

Conclusion: Our results suggest women with PCOS as more likely to develop hypertension from early adulthood, independent of BMI and with risk exacerbated by obesity.

Effect of household relocation on child vaccination and health service utilisation in Dhaka, Bangladesh: a cross-sectional community survey

OBJECTIVE

To explore the relationship between household relocation and use of vaccination and health services for severe acute respiratory illness (ARI) among children in Dhaka, Bangladesh.

DESIGN

Analysis of cross-sectional community survey data from a prior study examining the impact of Haemophilus influenzae type b vaccine introduction in 2009 on meningitis incidence in Bangladesh.

SETTING

Communities surrounding two large paediatric hospitals in Dhaka, Bangladesh.

PARTICIPANTS

Households with children under 5 years old who either recently relocated <12 months or who were residentially stable living >24 months in their current residence (total n=10 020) were selected for this study.

PRIMARY OUTCOME MEASURES

Full vaccination coverage among children aged 9-59 months and visits to a qualified medical provider for severe ARI among children under 5 years old.

RESULTS

Using vaccination cards with maternal recall, full vaccination was 80% among recently relocated children (n=3795) and 85% among residentially stable children (n=4713; χ²=37.2, p<0.001). Among children with ARI in the prior year, 69% of recently relocated children (n=695) had visited a qualified medical provider compared with 82% of residentially stable children (n=763; χ²=31.9, p<0.001). After adjusting for demographic and socioeconomic characteristics, recently relocated children were less likely to be fully vaccinated (prevalence ratio [PR] 0.97; 95% CI 0.95 to 0.99; p=0.016) and to have visited a qualified medical provider for ARI (PR 0.88; 95% CI 0.84 to 0.93; p<0.001).

CONCLUSIONS

Children in recently relocated households in Dhaka, Bangladesh, have decreased use of vaccination and qualified health services for severe ARI.

Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression

Women with polycystic ovary syndrome (PCOS) have increased risk of metabolic syndrome. The relative contribution of clinical, demographic or biochemical factors to metabolic syndrome in PCOS is not known. A literature search was conducted in MEDLINE, CINAHL, EMBASE and clinical trial registries. Of 4530 studies reviewed, 59 were included in the systematic review and 27 in the meta-analysis and meta-regression. In good and fair quality studies, women with PCOS had an overall increased prevalence of metabolic syndrome (odds ratio, OR 3.35, 95% confidence interval, CI 2.44, 4.59). Increased prevalence of metabolic syndrome occurred in overweight or obese women with PCOS (OR 1.88, 95% 1.16, 3.04) but not in lean women (OR 1.45, 95% CI 0.35, 6.12). In meta-regression analyses, the markers of metabolic syndrome diagnostic criteria (waist circumference, high-density lipoprotein cholesterol, triglyceride, blood pressure), BMI, glucose tolerance (2-hr oral glucose tolerance test) and surrogate markers of insulin resistance (HOMA-IR) but not markers of reproductive dysfunction (sex hormone binding globulin, testosterone, PCOS phenotypes) contributed significantly to the heterogeneity in the prevalence of metabolic syndrome. Women with PCOS have increased risk of metabolic syndrome which was associated with obesity and metabolic features but not with indices of hyperandrogenism.

Ethnicity, obesity and the prevalence of impaired glucose tolerance and type 2 diabetes in PCOS: a systematic review and meta-regression

BACKGROUND

Our prior meta-analyses demonstrated an increased prevalence of impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) with polycystic ovary syndrome (PCOS), but with substantial clinical heterogeneity.

OBJECTIVE AND RATIONALE

We aimed to update our previous review to quantify the prevalence of IGT and T2DM in PCOS with only quality studies (good and fair quality). We also aimed to examine the contribution of parameters including ethnicity, obesity and method of diagnosing T2DM in explaining the observed heterogeneity in IGT and T2DM prevalence in PCOS.

SEARCH METHODS

We conducted a literature search (MEDLINE, CINAHL, EMBASE, clinical trial registries and hand-searching) up to June 2016 to identify studies reporting the prevalence of dysglycemia (IGT and T2DM) in women with and without PCOS. We included studies where women with PCOS (defined according to original National Institute of Health) were compared to women without PCOS for the end-points of the prevalence of IGT or T2DM. We excluded case reports, case series, editorials, and narrative reviews. Studies where PCOS was diagnosed by self-report, or where IGT or T2DM were measured by fasting glucose, only were excluded. We assessed the methodological quality of the included studies using a priori criteria based on the Newcastle-Ottawa Scaling (NOS) for non-randomized studies. Data are presented as odds ratio (OR) (95% CI) with random-effects meta-analysis by Mantel-Haenszel methods. We assessed the contribution of demographic and clinical factors to heterogeneity using subgroup and meta-regression analysis.

OUTCOMES

We reviewed 4530 studies and included 40 eligible studies in the final analysis. On meta-analysis of quality studies, women with PCOS had an increased prevalence of IGT (OR = 3.26, 95% CI: 2.17-4.90) and T2DM (OR = 2.87, 95% CI: 1.44-5.72), which differed by ethnicity (for IGT, Asia: 5-fold, the Americas: 4-fold and Europe: 3-fold), was higher with obesity, and doubled among studies using self-report or administrative data for diagnosing diabetes. The ethnicity-related difference retained its significance for Asia and Europe in BMI-matched subgroups. Clear contributors to heterogeneity did not emerge in meta-regression.

WIDER IMPLICATIONS

Our findings underscore the importance of PCOS as a cause of dysglycemia with a higher prevalence of IGT and T2DM. They support the relevance of ethnicity and obesity and emphasize the need for accurate diagnostic methods for diabetes.

PROSPERO REGISTRATION NUMBER

CRD42017056524.

Cardiometabolic risks in PCOS: a review of the current state of knowledge

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 18% women of reproductive age. It is associated with a range of metabolic, reproductive, and psychological features. Current evidence indicates a role of PCOS in the development of metabolic and increased cardiovascular risk factors (CVRF) with implications for compromised cardiovascular endpoint disease, which may have a considerable impact on health and health care costs.

AREAS COVERED

Existing studies examining long-term cardiometabolic health in PCOS are heterogeneous with inconsistent findings. In the current review, we aim to explore and critically review retrospective, prospective, meta-analysis and review articles relating to PCOS on cardiometabolic risk factors and clinical consequences to summarize the evidence, note evidence gaps, and suggest implications for future research.

EXPERT COMMENTARY

Although there is an established association between PCOS and metabolic health, implications on cardiac health are more uncertain with associations observed for CVRF and subclinical disease, yet limited and conflicting data on actual cardiovascular endpoints. There is a lack of population-based long-term studies examining cardiometabolic morbidity and mortality in PCOS with a need for further research to progress toward a better understanding of the long-term cardiometabolic impacts in women with PCOS.

Group-based developmental BMI trajectories, polycystic ovary syndrome, and gestational diabetes: a community-based longitudinal study

BACKGROUND

Obesity is common in young women, increasing insulin resistance (IR) and worsening pregnancy complications, including gestational diabetes (GDM). Women with polycystic ovary syndrome (PCOS) are commonly obese, which aggravates the severity of PCOS clinical expression. Relationships between these common insulin-resistant conditions, however, remain unclear.

METHODS

We conducted a secondary analysis of the Australian Longitudinal Study on Women's Health (ALSWH) database, including data from 8009 women aged 18-36 years across six surveys. We used latent-curve growth modelling to identify distinct body mass index (BMI) trajectories and multinomial logistic regression to explore sociodemographic and health variables characterizing BMI group membership. Logistic regression was used to assess independent risk of GDM.

RESULTS

A total of 662 women (8.29%, 95% CI 7.68-8.89) reported PCOS. Three distinct BMI trajectories emerged, namely low stable (LSG) (63.8%), defined as an average trajectory remaining at ~25 kg/m²; moderately rising (MRG) (28.8%), a curvilinear trajectory commencing in a healthy BMI and terminating in the overweight range; and high-rising (HRG) (7.4%), a curvilinear trajectory starting and terminating in the obese range. A high BMI in early reproductive life predicted membership in higher trajectories. The HRG BMI trajectory was independently associated with GDM (OR 2.50, 95% CI 1.80-3.48) and was a stronger correlate than PCOS (OR 1.89, 95% CI 1.41-2.54), maternal age, socioeconomic status, or parity.

CONCLUSION

Our results suggest heterogeneity in BMI change among Australian women of reproductive age, with and without PCOS. Reducing early adult life weight represents an ideal opportunity to intervene at an early stage of reproductive life and decreases the risk of long-term metabolic complications such as GDM.