1
|
Demirchyan A, Dudareva S, Sahakyan S, Aslanyan L, Muradyan D, Musheghyan L, Mozalevskis A, Sargsyants N, Ghukasyan G, Petrosyan V. Prevalence of hepatitis B virus infection among general population of Armenia in 2021 and factors associated with it: a cross-sectional study. BMJ Open 2024; 14:e080281. [PMID: 38326250 PMCID: PMC10860008 DOI: 10.1136/bmjopen-2023-080281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES This study sought to determine the prevalence and associated factors of hepatitis B virus (HBV) infection ever in life and chronic HBV infection in Armenia. DESIGN A population-based cross-sectional seroprevalence study combined with a phone survey of tested individuals. SETTING All administrative units of Armenia including 10 provinces and capital city Yerevan. PARTICIPANTS The study frame was the general adult population of Armenia aged ≥18 years. PRIMARY AND SECONDARY OUTCOME MEASURES The participants were tested for anti-HBV core antibodies (anti-HBc) and HBV surface antigen (HBsAg) using third-generation enzyme immunoassays. In case of HBsAg positivity, HBV DNA and hepatitis D virus (HDV) RNA PCR tests were performed. Risk factors of HBV infection ever in life (anti-HBc positivity) and chronic HBV infection (HBsAg positivity) were identified through fitting logistic regression models. RESULTS The seroprevalence study included 3838 individuals 18 years and older. Of them, 90.7% (3476 individuals) responded to the phone survey. The prevalence of anti-HBc positivity was 14.1% (95% CI 13.1% to 15.2%) and HBsAg positivity 0.8% (95% CI 0.5% to 1.1%). The viral load was over 10 000 IU/mL for 7.9% of HBsAg-positive individuals. None of the participants was positive for HDV. Risk factors for HBsAg positivity included less than secondary education (aOR=6.44; 95% CI 2.2 to 19.1), current smoking (aOR=2.56; 95% CI 1.2 to 5.6), and chronic liver disease (aOR=8.44; 95% CI 3.0 to 23.7). In addition to these, risk factors for anti-HBc positivity included age (aOR=1.04; 95% CI 1.04 to 1.05), imprisonment ever in life (aOR=2.53; 95% CI 1.41 to 4.56), and poor knowledge on infectious diseases (aOR=1.32; 95% CI 1.05 to 1.67), while living in Yerevan (vs provinces) was protective (aOR=0.74; 95% CI 0.59 to 0.93). CONCLUSION This study provided robust estimates of HBV markers among general population of Armenia. Its findings delineated the need to revise HBV testing and treatment strategies considering higher risk population groups, and improve population knowledge on HBV prevention.
Collapse
Affiliation(s)
- Anahit Demirchyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Sandra Dudareva
- Department for Infectious Disease Epidemiology, Robert Koch Institut, Berlin, Germany
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Lusine Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Diana Muradyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Lusine Musheghyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Antons Mozalevskis
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Narina Sargsyants
- National Institute of Health named after academician Suren Avdalbekyan, Yerevan, Armenia
| | - Gayane Ghukasyan
- World Health Organization Country Office in Armenia, Yerevan, Armenia
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| |
Collapse
|
2
|
Sahakyan S, Muradyan D, Giloyan A, Harutyunyan T. Factors associated with delay or avoidance of medical care during the COVID-19 pandemic in Armenia: results from a nationwide survey. BMC Health Serv Res 2024; 24:20. [PMID: 38178214 PMCID: PMC10768194 DOI: 10.1186/s12913-023-10483-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems throughout the world. Many patients faced delays and cancellation of care due to scaled back services, mobility restrictions, and concerns related to the risk of infection. The present study aimed to assess the prevalence of and risk factors associated with the avoidance or delay of medical care due to COVID-19 in Armenia. METHODS We conducted a cross-sectional telephone survey of 3,483 adults across Armenia. We used stratified two-stage cluster sampling to select the participants from different age groups proportionate to their size in the population. Logistic regression analysis assessed the association of risk factors with avoidance/delay of routine, urgent/emergency, and any medical care. RESULTS The mean age of the sample was 49.5 (SD = 14.8), ranging from 18 to 90. About 9.9% of the respondents avoided/delayed any type of medical care; whereas 5.5% avoided/delayed urgent/emergency care and 6.6% routine care. In the adjusted analysis, female gender and higher monthly expenditures were associated with avoidance/delay of routine medical care. Factors associated with delay/avoidance of urgent/emergency care included female gender and higher perceived threat of COVID-19. Younger age, female gender, higher perceived threat and not being vaccinated against COVID-19 were associated with avoidance/delay of any medical care in the adjusted analysis. CONCLUSION Since avoiding or delaying care might increase morbidity and mortality associated with conditions not related to COVID-19, identifying population groups that are more likely to avoid care is important. Targeting such groups with educational interventions focusing on the risks of using versus not using medical care in times of pandemic might be crucial. Ensuring the provision of in-home healthcare services for high-risk groups might help to address important medical care needs during the pandemic.
Collapse
Affiliation(s)
- Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia
| | - Diana Muradyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia.
| | - Aida Giloyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia
| | - Tsovinar Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, Yerevan, 0019, Armenia
| |
Collapse
|
3
|
Harutyunyan T, Sargsyan Z, Sahakyan S, Chiloyan A, Melkom Melkomian D, Khachadourian V. Predicting COVID-19 vaccination uptake in Armenia using the Health Belief Model: Results from a nationwide survey. Hum Vaccin Immunother 2023; 19:2165383. [PMID: 36688424 PMCID: PMC9980550 DOI: 10.1080/21645515.2023.2165383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Health behavior theories have been effectively used for studying populations' awareness, attitudes, and beliefs related to COVID-19 preventative behaviors. The aim of this study was to explore the factors associated with the intention to get vaccinated against COVID-19 in the Armenian population using the Health Belief Model (HBM) as a framework. We applied stratified two-stage random sampling to conduct a telephone survey of 3,483 adults in 2021. The multi-domain survey instrument included questions on socio-demographic characteristics, COVID-19-related knowledge, COVID-19 susceptibility, severity and self-efficacy beliefs, sources of information on COVID-19, COVID-19 vaccination practice, and its benefits and barriers. We performed bivariate and hierarchical multivariate regression analysis with the entry of variables in blocks. In total, about 12% of the sample (n = 393) was vaccinated against COVID-19. Of 2,838 unvaccinated participants, about 53% (n = 1516) had an intention to get vaccinated. The final hierarchical logistic regression model containing socio-demographic characteristics, knowledge about COVID-19, and HBM constructs explained 43% of the variance in the intention to get vaccinated against COVID-19. Participants' age, employment status, average monthly expenditures, perceived threat, benefits, perceived barriers, self-efficacy, and cues to action were significant and independent predictors of the intention to get COVID-19 vaccination. This study confirmed the utility of the HBM in highlighting drivers of an important health-protective behavior in the context of pandemics. Health policy makers, communication specialists, and healthcare providers should particularly stress the effectiveness and safety of the vaccines in their efforts to increase vaccination rates and focus on unemployed and low-income population groups.
Collapse
Affiliation(s)
- Tsovinar Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Araz Chiloyan
- Public Health Department, Ministry of Health, Yerevan, Armenia
| | | | - Vahe Khachadourian
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| |
Collapse
|
4
|
Müller SA, Agweyu A, Akanbi OA, Alex-Wele MA, Alinon KN, Arora RK, Balam S, Barekye B, Ben Hamida A, Bergeri I, Boddington N, Böff L, Boone I, Conradie A, Demirchyan A, Dudareva S, El Bcheraoui C, Evans M, Farley E, Hunger I, Jones JM, Kagucia EW, Kimani M, Lewis HC, Mazuguni F, Mwakasungula S, Mwenda JM, Nesterova O, Nepolo E, Nghitukwa N, Nyagwange J, Offergeld R, Okwor TJ, Reichert F, Sahakyan S, Shaikh S, Sikuvi KA, Weiss S, Whelan M, Winter CH, Ziraba AK, Hanefeld J. Learning from serosurveillance for SARS-CoV-2 to inform pandemic preparedness and response. Lancet 2023; 402:356-358. [PMID: 37247625 PMCID: PMC10219629 DOI: 10.1016/s0140-6736(23)00964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/31/2023]
|
5
|
Sahakyan S, Gharibyan N, Aslanyan L, Hayrumyan V, Harutyunyan A, Libaridian L, Grigoryan Z. Multi-Perspective Views and Hesitancy toward COVID-19 Vaccines: A Mixed Method Study. Vaccines (Basel) 2023; 11:vaccines11040801. [PMID: 37112713 PMCID: PMC10147024 DOI: 10.3390/vaccines11040801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
The worldwide uptake of COVID-19 vaccines was suboptimal throughout the pandemic; vaccine hesitancy played a principle role in low vaccine acceptance both globally and in Armenia. In order to understand the factors behind the slow vaccine uptake in Armenia, we aimed to explore the prevailing perceptions and experiences of healthcare providers and the general public related to COVID-19 vaccines. The study applied a convergent parallel mixed-methods study design (QUAL-quant) through in-depth interviews (IDI) and a telephone survey. We completed 34 IDIs with different physician and beneficiary groups and a telephone survey with 355 primary healthcare (PHC) providers. The IDIs found that physicians held variable views on the need for COVID-19 vaccination which, combined with mixed messaging in the media landscape, fueled the public’s vaccine hesitancy. The survey results were mostly consistent with the qualitative findings as 54% of physicians hypothesized that COVID-19 vaccines were rushed without appropriate testing and 42% were concerned about the safety of those vaccines. Strategies to improve vaccination rates must target the main drivers of hesitancy, such as physicians’ poor knowledge of specific vaccines and spiraling misconceptions about them. Meanwhile, timely educational campaigns with targeted messaging for the general public should address misinformation, promote vaccine acceptance, and empower their capacity to make decisions about their health.
Collapse
Affiliation(s)
- Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Natella Gharibyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Lusine Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Arusyak Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| | - Lorky Libaridian
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA
| | - Zaruhi Grigoryan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan 0019, Armenia
| |
Collapse
|
6
|
Aslanyan L, Arakelyan Z, Atanyan A, Abrahamyan A, Karapetyan M, Sahakyan S. Primary healthcare providers challenged during the COVID-19 pandemic: a qualitative study. BMC Prim Care 2022; 23:310. [PMID: 36463103 PMCID: PMC9719166 DOI: 10.1186/s12875-022-01923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Primary healthcare (PHC) providers are widely acknowledged for putting the most efficient and long-lasting efforts for addressing community health issues and promoting health equity. This study aimed to explore PHC providers' experiences with coronavirus pandemic preparedness and response in Armenia. METHODS We applied a qualitative study design using semi-structured in-depth interviews and structured observation checklists. Study participants were recruited using theoretical and convenience sampling techniques throughout Armenia. Inductive conventional content analysis was utilized to analyze the in-depth interviews. Nineteen in-depth interviews were conducted with 21 participants. Observations took place in 35 PHC facilities. The data collected during the observations was analyzed using the "SPSS22.0.0.0" software. RESULTS Five main themes of primary healthcare providers' experiences were drawn out based on the study findings: 1) the gap in providers' risk communication skills; 2) uneven supply distributions; 3) difficulties in specimen collection and testing processes; 4) providers challenged by home visits; 5) poor patient-provider relationships. The results revealed that primary care providers were affected by uneven supply distribution throughout the country. The lack of proper laboratory settings and issues with specimen collection were challenges shaping the providers' experiences during the pandemic. The study highlighted the health systems' unpreparedness to engage providers in home visits for COVID-19 patients. The findings suggested that it was more challenging for healthcare providers to gain the trust of their patients during the pandemic. The study results also underlined the need for trainings to help primary care providers enhance their risk communication expertise or assign other responsible bodies to carry out risk communication on PHC providers' behalf. CONCLUSION The study discovered that PHC providers have a very important role in healthcare system's preparedness and response to handle public health emergencies such as the COVID-19 pandemic. Based on the findings the study team recommends prioritizing rural PHC development, ensuring appropriate supply distributions, developing comprehensive protocols on safe home visits and specimen collection and testing processes, and trainings PHC providers on risk communication, patient-centeredness, as well as proper use of personal protective equipment.
Collapse
Affiliation(s)
- Lusine Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Zaruhi Arakelyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Astghik Atanyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Arpine Abrahamyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Manya Karapetyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia
| |
Collapse
|
7
|
Sargsyan Z, Grigoryan Z, Sahakyan S, Kelenjian K, Hayrumyan V, Agopian A, Harutyunyan T. Socio-demographic determinants of infectious disease knowledge in Armenia. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is substantial evidence that infectious disease knowledge (IDK) predicts people's behavioral intentions and preventive practices. Since level of IDK varies across socio-economic contexts and imposes a substantial burden on vulnerable groups, we aimed to assess the relationship between socio-demographic factors and IDK in the adult population of Armenia.
Methods
A cross-sectional nationwide phone survey was conducted in the capital Yerevan and all Armenian provinces in 2021, using a stratified two-stage cluster sampling to complete a sample of 3,483 respondents. The questions on socio-demographic characteristics and IDK were included in a multi-domain structured survey questionnaire. Four questions measured IDK; a summative IDK score (0-4) was used in bivariate and multivariate linear regression analysis.
Results
Females constituted 71.0% of the sample. The mean age was 49.5 years. About 68% of the study participants had some vocational (12-13 years) or university degree education and 54.4% were employed. About one fifth of the respondents reported family monthly expenditures of less than 100,000 Armenian drams (AMD) ≈ $200, while the majority reported spending 101,000AMD to 400,000 AMD per month. The mean IDK score was 2.48. In the adjusted analysis, being female, holding a higher education level, being employed, having younger age and higher family monthly expenditures were positively associated with IDK score.
Conclusions
Our findings suggest that there is a gap in IDK affecting specific population groups such as older people, those with incomplete or secondary education, unemployed and financially disadvantaged people. Educational interventions and campaigns should target these groups to minimize the gap and ensure even prerequisites for good health.
Key messages
• Gender, age, education level, employment status and income level all independently influence population’s infectious disease knowledge.
• Health communication campaigns on infectious disease knowledge should particularly target males, older people and socially disadvantaged groups.
Collapse
Affiliation(s)
- Z Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - Z Grigoryan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - S Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - K Kelenjian
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Agopian
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - T Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| |
Collapse
|
8
|
Hayrumyan V, Abrahamyan A, Harutyunyan A, Sahakyan S. Impact of COVID-19 on the essential healthcare services at primary healthcare level. Eur J Public Health 2022. [PMCID: PMC9593975 DOI: 10.1093/eurpub/ckac131.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The COVID-19 pandemic triggered numerous challenges for the healthcare systems worldwide, particularly affecting the continuity of essential health services in low- and middle-income countries. We explored the effects of the COVID-19 pandemic on the utilization and delivery of essential health services in Armenia. Methods We applied a conventional qualitative study design using semi-structured in-depth interviews (n = 17) in public and private primary healthcare (PHC) facilities in Armenia (2021). Participants included physicians providing primary health services (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular PHC facility patients (e.g. adults with chronic diseases, parents of children), and policymakers. Iterative thematic analysis was done based on inductively emerged 3 main themes: patient-provider communications, maternal and child health services, and management of chronic diseases. Results Overall, visits to the PHC facilities were decreased due to fear to contract COVID-19 coupled with lack of information, misinformation and panic. There was a lack of digital platforms for ensuring continuous patient-provider communication and phone calls were the main way of communication. PHC providers intentionally limited the number of maternal and child visits to only essential antenatal visits, newborn screenings and routine child immunizations. Still, the latter has suffered resulting in delayed and decreased vaccinations. The pandemic remarkably decreased the number of follow-up visits and monitoring of patients with chronic conditions resulting in more critical and severe conditions. Conclusions The COVID-19 pandemic affected the provision and utilization of essential health services at PHC facilities by changing people’s health-seeking behavior. Unified national-level guidance for PHC facilities is needed to direct the provision of essential services, effective health communication and usage of digital platforms. Key messages • Though provider encounters should be limited during outbreaks, continuous provision of essential services is critical in the prevention of morbidity, complications and worsened disease severity. • Efforts are needed to develop effective health and risk communication strategies and enhance appropriate usage of digital platforms to promote adequate health-seeking behavior among the public.
Collapse
Affiliation(s)
- V Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Abrahamyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - S Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| |
Collapse
|
9
|
Demirchyan A, Sahakyan S, Aslanyan L, Mushegyan L, Muradyan D, Mozalevskis A, Sargsyants N, Ghukasyan G, Petrosyan V. Prevalence and risk factors of hepatitis C virus infection in Armenia, 2021. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Liver damage caused by hepatitis C virus (HCV) is common, especially in low- and middle-income countries. Chronic HCV infection is among the leading causes of chronic liver disease, cirrhosis and hepatocellular carcinoma. Data on prevalence and risk factors of HCV infection are important for planning effective interventions to fight the virus. This study investigated the prevalence of HCV, its genotypes and factors associated with chronic HCV infection in Armenia.
Methods
The study included 3838 individuals 18 years and older selected via stratified two-stage cluster sampling from all regions of Armenia. Anti-HCV antibodies were detected using a third generation immunoassay. Those testing positive were further tested by Polymerase Chain Reaction and genotyping. Shortly after testing, the participants underwent a telephone survey. Logistic regression model was fitted to identify factors associated with chronic HCV infection.
Results
The participants mean age was 49.5 years, 70.0% were female. The prevalence of HCV antibodies weighted by age and sex was 1.9% (95% CI 1.5, 2.3), and chronic HCV infection - 0.7% (95% CI 0.4, 0.9), with genotype 3 being the most common (41.7%), followed by genotypes 2 (37.5%) and 1 (20.8%). The prevalence of both antibodies and chronic infection were higher among 50-69 years old (3.4% and 1.3%, respectively). In weighted analysis, the risk factors for chronic HCV infection included male sex (95% CI 1.23, 11.59), having tattoos (95% CI 1.10, 7.80), and reporting liver disease (95% CI 1.24, 14.61). Being employed was protective (95% CI 0.14, 0.93).
Conclusions
This study was the first attempt to measure the prevalence of HCV infection among the general population of Armenia, creating prerequisites for estimating the HCV-related disease burden and developing strategies to cope with it. The identified risk factors demonstrate that there is still room for strengthening safety measures to prevent the transmission of HCV in Armenia.
Key messages
• The prevalence of HCV antibodies is 1.9% among adult population of Armenia, increasing with age. Over one-third of seropositive cases have chronic infection caused by HCV genotypes 3, 2 or 1.
• Having tattoos is associated with higher risk of being infected with HCV, demonstrating the need for strengthening safety measures during similar procedures to prevent viral transmission.
Collapse
Affiliation(s)
- A Demirchyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - S Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - L Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - L Mushegyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - D Muradyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Mozalevskis
- WHO Regional Office for Europe , Copenhagen, Denmark
| | - N Sargsyants
- National Centre for Infectious Diseases , Yerevan, Armenia
| | - G Ghukasyan
- WHO Country Office in Armenia , Yerevan, Armenia
| | - V Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| |
Collapse
|
10
|
Musheghyan L, Sahakyan S, Sargsyan Z, Muradyan D, Aslanyan L, Gharibyan N, Harutyunyan A, Khachadourian V, Petrosyan V. Predictors of seropositivity against SARS-COV-2: a population-based seroepidemiological study. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Data on parameters of actual exposure to SARS-CoV-2 is limited, and specific population groups might be at a higher risk of infection. In line with the growing need for large-scale investigations to determine the presence of antibodies against SARS-CoV-2 among different population groups, we conducted a nationwide assessment in Armenia.
Methods
We performed a cross-sectional seroepidemiological study among the adult population in Armenia, in May-September 2021. A multi-stage cluster random sampling was performed to recruit the participants across the capital city and regions. The study had two main components: blood sampling, which took place in primary care facilities and a phone survey on socio-demographic characteristics, comorbidities, and previous history of COVID-19.
Results
The number of participants included in both blood sampling and phone survey was 3483. The nationwide prevalence of SARS-CoV 2 antibodies weighted by age and gender was 66.4% with significantly higher prevalence in urban compared to rural areas (67.3% vs 59.3%, p < 0.001). Only 22.7% (n = 772) of the total sample reported a previous history of PCR confirmed COVID-19, among whom antibodies were detected in 94.2% (n = 727). In the final adjusted model, the seropositivity was associated with being female (OR = 1.60, 95% CI: 1.32; 1.92), employed (OR = 1.41, 95% CI: 1.17; 1.69), and having previous PCR confirmed COVID-19 (OR = 10.6, 95% CI: 7.39; 15.21).
Conclusions
Over 66% of the population were seropositive for antibodies against SARS-CoV 2; and over ⅕ of the sample reported a previous PCR diagnosis. Factors associated with increased odds of seropositivity included gender, employment status, and place of residence. Targeted interventions are recommended to minimize the risk of infection among those groups, including vaccination and infection prevention and control measures.
Key messages
• The prevalence of SARS-CoV 2 antibodies is about three times higher than the rate of infection based on PCR confirmed prevalence of COVID-19.
• Women, people living in urban areas, and those employed are at a higher risk for exposure to SARS-CoV 2.
Collapse
Affiliation(s)
- L Musheghyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - S Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - Z Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - D Muradyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - L Aslanyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - N Gharibyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Khachadourian
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| |
Collapse
|
11
|
Sahakyan S, Musheghyan L, Muradyan D, Sargsyan Z, Petrosyan V, Khachadourian V, Harutyunyan A. The impact of smoking on immunological response to SARS-COV 2: a nationwide seroepidemiological study. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Smoking influences cellular and humoral immune responses and affects the immune system by increasing inflammation and decreasing activity against infections. The current study investigates the association between smoking and immunological response to SARS-CoV-2 in the Armenian population.
Methods
We performed a nationwide cross-sectional seroepidemiological study among the adult population (≥18 years old) in Armenia. We used a multi-stage cluster random sampling to recruit participants from the capital city and all regions of Armenia. We invited selected participants to primary healthcare facilities to provide blood samples for antibody testing followed by a phone survey on demographic characteristics, smoking status, and other variables. Logistic regression analysis was used to test the relationship between smoking and having SARS-CoV-2 antibodies adjusted for other covariates.
Results
3483 people participated in the study (71% women). The total sample included 16.8% current smokers (n = 571), 8.6% past smokers (n = 294) and 76.4% never smokers (n = 2538). The prevalence of SARS CoV-2 antibodies among current smokers was statistically significantly lower as compared with never smokers (46.9% vs 73.4%, p-value<0.001). In the multivariable logistic regression model, the odds of having SARS CoV-2 antibodies among the current smokers was 70% lower (OR 0.30, 95%CI: 0.22; 0.40) compared to never smokers, when adjusted for demographic factors and the time of PCR diagnosis of COVID-19. No statistically significant difference was found between past smokers and having SARS CoV-2 antibodies.
Conclusions
In addition to being a risk factor for various chronic diseases, smoking weakens immune response to infectious diseases, including COVID-19, worsening the outcomes. The significantly lower level of antibody prevalence among smokers with previous PCR confirmed COVID 19 implies a poorer immune response to the infection and not a lower risk of getting the infection.
Key messages
• Smoking weakens immune response and contributes to a higher burden of infectious diseases, such as COVID-19.
• Lower level of antibody prevalence among smokers indicates a poorer immune response to the infection rather than a lower risk of getting the infection.
Collapse
Affiliation(s)
- S Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - L Musheghyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - D Muradyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - Z Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - V Khachadourian
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia , Yerevan, Armenia
| |
Collapse
|
12
|
Grigoryan Z, McPherson R, Harutyunyan T, Truzyan N, Sahakyan S. Factors Influencing Treatment Adherence Among Drug-Sensitive Tuberculosis (DS-TB) Patients in Armenia: A Qualitative Study. Patient Prefer Adherence 2022; 16:2399-2408. [PMID: 36072915 PMCID: PMC9444026 DOI: 10.2147/ppa.s370520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Despite the availability of effective treatment, tuberculosis (TB) is still one of the leading causes of mortality around the globe. Poor adherence to treatment challenges TB management both globally and locally. Proper adherence to treatment contributes to successful outcomes and prevents the development of drug-resistant forms of TB. PATIENTS AND METHODS We conducted a qualitative study to identify and describe the factors that facilitated treatment adherence among drug-sensitive TB (DS-TB) patients in Armenia. Sixteen in-depth interviews (IDIs) with former DS-TB patients, two IDIs with family members of former DS-TB patients, and a focus group discussion with healthcare providers who manage DS-TB patients were conducted. The educational and ecological assessment component of the PRECEDE-PROCEED model was applied as a conceptual framework to guide the interview content and data analysis. RESULTS Former patients' awareness of TB and its treatment, beliefs about TB, trust in TB healthcare providers, and a sense of responsibility were the most common factors that predisposed them to complete the treatment. Support received from providers, family, and friends, a desire to avoid TB-associated stigma, and good tolerance of TB medications were the main reinforcing factors. Enabling factors included a relatively simple regimen of TB treatment and accessibility and affordability of TB services. CONCLUSION The findings of the study provide new perspectives on factors that facilitate adherence to long-term therapies, such as TB. Interventions that aim to invoke a patient's sense of responsibility and positive beliefs about TB as well as engage families might promote the successful completion of treatment.
Collapse
Affiliation(s)
- Zaruhi Grigoryan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
- Correspondence: Zaruhi Grigoryan, Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramyan Ave, Yerevan, 0019, Armenia, Tel +37 460612617, Fax +37 460612512, Email
| | - Robert McPherson
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Tsovinar Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Nune Truzyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| |
Collapse
|
13
|
Ismatov B, Sereda Y, Sahakyan S, Gadoev J, Parpieva N. Hospitalizations and Treatment Outcomes in Patients with Urogenital Tuberculosis in Tashkent, Uzbekistan, 2016-2018. Int J Environ Res Public Health 2021; 18:ijerph18094817. [PMID: 33946457 PMCID: PMC8124920 DOI: 10.3390/ijerph18094817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Abstract
Despite the global shift to ambulatory tuberculosis (TB) care, hospitalizations remain common in Uzbekistan. This study examined the duration and determinants of hospitalizations among adult patients (≥18 years) with urogenital TB (UGTB) treated with first-line anti-TB drugs during 2016–2018 in Tashkent, Uzbekistan. This was a cohort study based on the analysis of health records. Of 142 included patients, 77 (54%) were males, the mean (±standard deviation) age was 40 ± 16 years, and 68 (48%) were laboratory-confirmed. A total of 136 (96%) patients were hospitalized during the intensive phase, and 12 (8%) had hospital admissions during the continuation phase of treatment. The median length of stay (LOS) during treatment was 56 days (Interquartile range: 56–58 days). LOS was associated with history of migration (adjusted incidence rate ratio (aIRR): 0.46, 95% confidence interval (CI): 0.32–0.69, p < 0.001); UGTB-related surgery (aIRR: 1.18, 95% CI: 1.01–1.38, p = 0.045); and hepatitis B comorbidity (aIRR: 3.18, 95% CI: 1.98–5.39, p < 0.001). The treatment success was 94% and it was not associated with the LOS. Hospitalization was almost universal among patients with UGTB in Uzbekistan. Future research should focus on finding out what proportion of hospitalizations were not clinically justified and could have been avoided.
Collapse
Affiliation(s)
- Bakhtiyor Ismatov
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent 100086, Uzbekistan;
- Correspondence: ; Tel.: +998-909-669-960
| | | | - Serine Sahakyan
- Armenia and Tuberculosis Research and Prevention Center NGO, Yerevan 0034, Armenia;
| | - Jamshid Gadoev
- World Health Organization (WHO) Country Office in Uzbekistan, Tashkent 100100, Uzbekistan;
| | - Nargiza Parpieva
- Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology, Tashkent 100086, Uzbekistan;
| |
Collapse
|
14
|
Sahakyan S, Akopyan K, Petrosyan V. Nurses role, importance and status in Armenia: A mixed method study. J Nurs Manag 2020; 28:1561-1569. [DOI: 10.1111/jonm.13109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Serine Sahakyan
- Turpanjian School of Public Health American University of Armenia Yerevan Armenia
| | - Kristina Akopyan
- Turpanjian School of Public Health American University of Armenia Yerevan Armenia
| | - Varduhi Petrosyan
- Turpanjian School of Public Health American University of Armenia Yerevan Armenia
| |
Collapse
|
15
|
Aslanyan L, Sahakyan S, Petrosyan V. An assessment of the Armenian national midwifery curriculum as per international standards. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Literature suggests increasing evidence that incompetent midwifery education results in poor quality of care. The study compared and evaluated the level of compliance of the Armenian national criterion on midwifery with the global competency standards and developed recommendations for improvement.
Methods
The study team conducted a document review using a standardized checklist, which was adapted from the International Confederation of Midwives (ICM) core assessment tools. The document review explored if the main knowledge and skills/ability related elements of each ICM competency were separately covered by different modules of the national criterion using a scoring system with categories: not met, partially met, fully met and unspecified.
Results
Although the national criterion did not have specifically defined competencies, most of the elements required by the ICM were present as specific learning outcomes under different modules of the criterion. Midwifery program curriculum was described as intensive with unnecessarily heavy workload. Additionally, the document review reviled that most of the learning outcome defined in modules of the national criterion focused more on theoretical knowledge rather than practical skills and abilities. Overall, the ICM required competency in provision of care during pregnancy was the most comprehensively covered one in the national criterion, while the competency in facilitation of abortion related care was the lowest covered. National criterion did not highlight the importance of topics such as women's rights and health, principles of epidemiology, statistical methods of research, cultural, local and ethical beliefs.
Conclusions
The systematic comparison of the national criterion with internationally recognized essential competencies demonstrates significant gaps. The study team recommends revisions to the national criterion to make it competency based.
Key messages
Midwifery education criteria in Armenia did not reflect internationally accepted midwifery competency’s fundamental philosophy and values. Given the shortcomings of the current national midwifery education criterion, a comprehensive revision of the competencies of midwives in Armenia should be considered.
Collapse
Affiliation(s)
- L Aslanyan
- Public Health, American University of Armenia, Yerevan, Armenia
| | - S Sahakyan
- Public Health, American University of Armenia, Yerevan, Armenia
| | - V Petrosyan
- Public Health, American University of Armenia, Yerevan, Armenia
| |
Collapse
|
16
|
Sahakyan S, Musheghyan L, Harutyunyan A, Khachadourian V. Moving towards people–centered approach in TB Health Care System: Armenia’s Experience. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Achieving integrated people-centered care requires interventions at various levels of the system, including policy changes and measures tailored to strengthen skills and competencies of health care providers. The national guidelines for TB care provision in Armenia provide a standardized approach for TB diagnosis and treatment, including systematic implementation of TB care services across the country. Before August 2019, the only option for drug-sensitive TB treatment was facility-based DOT.
Methods
In order to offer an alternative treatment option- family- based DOT, and bring TB services closer to patients' needs and values, the national guideline for TB care provision was updated to institutionalize the new approach. A series of nationwide professional development trainings was launched to assure that health care providers at the inpatient and outpatient settings effectively follow the new updates in the national guideline. These evidence-based trainings specifically aimed to equip healthcare providers with the necessary tools, knowledge, and the skillset for communicating with TB patients and building relationship and trust, offering their professional support. Along with patient counselling skills, the curriculum covered recent updates on TB epidemic, its social-psychological and behavioral risk factors, and advancements in TB diagnosis and treatment. All the participants were provided with a manual and other materials regarding the program.
Results
The Ministry of Health of the RA has approved the national guidelines on TB care (No 2277 - Ô±, August 19). This document includes information on people-centered TB treatment and institutionalizes the family-based DOT in Armenia. More than 90 percent of TB healthcare providers (98 physicians and 134 nurses) throughout Armenia participated in the trainings and received certificates. The RA Ministry of Health accredited the training curriculum with 11 continuing medical education credits for participation.
Collapse
Affiliation(s)
- S Sahakyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - L Musheghyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Khachadourian
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| |
Collapse
|
17
|
Sargsyan Z, Harutyunyan T, Sahakyan S. Factors associated with car safety seats’ use. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Road traffic injuries are the number one cause of death in children aged 5-14 years. The evidence shows that, if correctly installed and used, child restraints can reduce infants' death by approximately 70%, and deaths among children by up to 80%. In the absence of compulsory car safety seat (CSS) legislation in Armenia, parents play the decisive role in child passenger safety. This study aimed to investigate the practice of CSS-s among Armenian parents and to find the determinants of CSS use.
Methods
In 2018, the study team conducted a self-administered survey among parents of children 0-6 years old living in Yerevan, the capital of Armenia. Using two stage cluster sampling, 33 kindergartens were chosen as clusters by simple random sampling and from each cluster 10 parents received a questionnaire. The study team applied a multivariable logistic regression model using the backward elimination approach to finalize the independent predictors of CSS-s use.
Results
Overall, 263 parents returned completed questionnaires, of which 26.2% (69) were CSS users. The CSS non-users included those who did not have a CSS (163) or had a CSS but used it sometimes, seldom or never (31). The study results showed that the factors associated with the CSS-s use among Armenian parents in the adjusted analyses were age in children (OR = 0.61, p = 0.003), attitude score (OR = 1.53, p = 0.003), knowledge score (OR = 1.45, p = 0.011) regarding CSS-s, consistent driver's side seatbelt compliance (OR = 3.4, p = 0.005), and monthly expenditures (OR = 3.35, p = 0.024).
Conclusions
This study was the first exploration of Armenian parents' practice of CSS-s. Our findings might serve as a starting point for further research on proper use of CSS among Armenian parents not only in Yerevan, but across all regions of the country. The revealed predictors of parental CSS-s use might be used for the development of fruitful interventions to enhance the practice of CSS-s in Armenia.
Key messages
This was the first-time exploration of CSS-s practice and predictors of CSS-s use in Armenia, where there is no CSS law and parents play the sole role in child passenger safety. Educational interventions for children and their parents on the importance of age and size appropriate CSS-s usage will help increase CSS-s use among Armenian parents.
Collapse
Affiliation(s)
- Z Sargsyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - T Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - S Sahakyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| |
Collapse
|
18
|
Musheghyan L, Sahakyan S, Harutyunyan A, Khachadourian V. Integrating psycho–social counselling in TB Services in Armenia. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Community or family-based DOT improves clinical outcomes and quality of life of TB patients compared to facility-based DOT. Based on a previously conducted clinical trial and recommended best practice guidelines, Armenia started the institutionalization of the family-based DOT in 2019, as an important component of the integrated people-centered approach in TB treatment. Psycho-social counselling and education played a crucial role in preparing patients/family members for this new model of care.
Methods
To facilitate the family-based DOT, multidisciplinary counseling teams consisting of a TB nurse and a psychologist or a TB nurse and a social worker were formed and further incorporated into the existing TB care system. After a systematic evaluation the strongest applicants were shortlisted, interviewed, and selected. They underwent a three-day training, improving their knowledge on TB disease, its transmission, diagnosis and treatment; patient counseling with an emphasis on motivational interviewing techniques; and people-centered TB care. A comprehensive package of procedural documents was developed to facilitate the counseling teams work process, including a guideline on counseling, reporting forms, and patients' educational materials. At an early stage of TB treatment, the counseling teams provide psycho-social counselling to patients and their families, and educate them on TB risk factors and infection control.
Results
The counselling teams have been based in the National Center of Pulmonology of the RA and provide psycho-social counselling to all drug susceptible TB patients and their family members all over Armenia. The counseling teams prepare patients/family members for the family-based DOT and provide continuous support during the entire treatment. The integration of counselling teams in the TB care system has provided the required human resource and capacity for the successful adoption of a new model of people-centered TB care in Armenia.
Collapse
Affiliation(s)
- L Musheghyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - S Sahakyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - A Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Khachadourian
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| |
Collapse
|
19
|
Sahakyan S, Aslanyan L, Hovhannisyan S, Petrosyan V. An Evaluation of Midwifery Education System in Armenia. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Competencies, knowledge and skills of health care professionals largely depend upon their education. Well-educated and competent midwives can improve women’s and infants’ health related outcomes. The current study evaluated the compliance of the current midwifery education system in Armenia with the global International Confederation of Midwives (ICM) standards.
Methods
The research team used a qualitative cross-sectional study design with deductive content analysis. Through purposeful sampling we recruited five nursing colleges providing midwifery education in Armenia; two in the capital city and three in different regions. The study population included midwifery students, faculty and administrative representatives of the selected colleges (n = 56). During fall 2018, we conducted observations of midwifery education textbooks and equipment and in-depth interviews and focus group discussions with participants.
Results
Despite widely used interactive teaching methodology and more than 60% of teaching time allocated for practical learning, students graduated from the program without obtaining essential competencies. Lack of teaching resources, especially in the regional colleges, and lack of quality clinical learning opportunities in hospitals were barriers for students to develop essential practical skills.
Conclusions
The study recommends the governmental bodies to ensure provision of equity-based distribution of finances and tangible resources between the capital city and regional nursing colleges. The practical component of midwifery education programs need substantial enhancement.
Key messages
The lack of teaching resources and access to hospital sites were barriers to obtaining essential competencies for midwifery students. In order to develop a sufficient professional skillset, midwifery education programs should arrange comprehensive and structured practical experience for students.
Collapse
Affiliation(s)
- S Sahakyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - L Aslanyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - S Hovhannisyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Petrosyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| |
Collapse
|
20
|
Hovhannesyan K, Sahakyan S, Davtyan K, Gasparyan S, Sarkisyan T, Reid AJ. Epidemiology and management of familial Mediterranean fever in Armenia: national audit from 1999 to 2018. Clin Exp Rheumatol 2019; 37 Suppl 121:154-155. [PMID: 30873950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/11/2019] [Indexed: 06/09/2023]
Affiliation(s)
| | - Serine Sahakyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Karapet Davtyan
- FMD K & L, Yerevan, and TB Research and Prevention Center NGO, Yerevan, Armenia
| | | | - Tamara Sarkisyan
- Center of Medical Genetics and Primary Health Care, Yerevan, Armenia
| | - Anthony John Reid
- Operational Research Unit, Operational Centre Brussels, Médecins sans Frontières, Luxembourg
| |
Collapse
|
21
|
Sahakyan S, Petrosyan V, Abrahamyan L. Diabetes mellitus and treatment outcomes of pulmonary tuberculosis: a cohort study. Int J Public Health 2019; 65:37-43. [PMID: 31240332 DOI: 10.1007/s00038-019-01277-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 06/19/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the impact of diabetes on the treatment outcomes among pulmonary TB patients in Yerevan, Armenia. METHODS We utilized a cohort study design that included TB patients with diabetes and TB patients without diabetes. The data collection was conducted in the National Tuberculosis Control Center, eight tuberculosis outpatient centers and the 'Prisoners' Hospital' in Yerevan, Armenia. Data were collected from an existing national TB database and patients medical records. Multivariable logistic regressions were conducted to construct the final model and test the associations. RESULTS The final sample included 621 patients 5.8% of whom had diabetes. The odds of having treatment failure was 8.99 times higher among TB patients with diabetes (95% confidence interval 2.51-32.23) compared to TB patients without diabetes after adjusting for weight and sputum smear status. CONCLUSIONS Diabetes comorbidity had a negative effect on TB treatment outcomes. Countries with a high burden of both TB and diabetes need to develop mechanisms for active screening for diabetes among patients with TB and address their treatment needs carefully.
Collapse
Affiliation(s)
- Serine Sahakyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Room 410W, Baghramyan 40, 0019, Yerevan, Armenia.
| | - Varduhi Petrosyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Room 410W, Baghramyan 40, 0019, Yerevan, Armenia
| | - Lusine Abrahamyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Room 410W, Baghramyan 40, 0019, Yerevan, Armenia.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| |
Collapse
|
22
|
Sahakyan S, Harutyunyan A, Abelyan G, Petrosyan V. Smoking and Caries Experience among Dental Visitors in Armenia. Tob Prev Cessat 2019. [DOI: 10.18332/tpc/105225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
23
|
Sahakyan S, Petrosyan V, Abrahamyan L. Retrospective cohort study of lost to follow up predictors among TB patients in Yerevan, Armenia. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Sahakyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Petrosyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - L Abrahamyan
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Cape Verde
| |
Collapse
|
24
|
Sahakyan S, Akopyan K, Petrosyan V. Exploring nursing profession in Armenia from nurses prospective: a qualitative study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Sahakyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - K Akopyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - V Petrosyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| |
Collapse
|
25
|
Akopyan K, Sahakyan S, Petrosyan V. Nursing practice in Armenia: a nationwide qualitative assessment 2016. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
26
|
Sahakyan S, Petrosyan V, Abrahamyan L. Risk factors of mortality in pulmonary TB patients in Yerevan, Armenia. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw166.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
27
|
Sahakyan S, Akopyan K, Petrosyan V, Nazarians K, White K. A nationwide assessment of nursing education in Armenia. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|