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Picinini Freitas L, Douwes-Schultz D, Schmidt AM, Ávila Monsalve B, Salazar Flórez JE, García-Balaguera C, Restrepo BN, Jaramillo-Ramirez GI, Carabali M, Zinszer K. Zika emergence, persistence, and transmission rate in Colombia: a nationwide application of a space-time Markov switching model. Sci Rep 2024; 14:10003. [PMID: 38693192 PMCID: PMC11063144 DOI: 10.1038/s41598-024-59976-7] [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] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/17/2024] [Indexed: 05/03/2024] Open
Abstract
Zika, a viral disease transmitted to humans by Aedes mosquitoes, emerged in the Americas in 2015, causing large-scale epidemics. Colombia alone reported over 72,000 Zika cases between 2015 and 2016. Using national surveillance data from 1121 municipalities over 70 weeks, we identified sociodemographic and environmental factors associated with Zika's emergence, re-emergence, persistence, and transmission intensity in Colombia. We fitted a zero-state Markov-switching model under the Bayesian framework, assuming Zika switched between periods of presence and absence according to spatially and temporally varying probabilities of emergence/re-emergence (from absence to presence) and persistence (from presence to presence). These probabilities were assumed to follow a series of mixed multiple logistic regressions. When Zika was present, assuming that the cases follow a negative binomial distribution, we estimated the transmission intensity rate. Our results indicate that Zika emerged/re-emerged sooner and that transmission was intensified in municipalities that were more densely populated, at lower altitudes and/or with less vegetation cover. Warmer temperatures and less weekly-accumulated rain were also associated with Zika emergence. Zika cases persisted for longer in more densely populated areas with more cases reported in the previous week. Overall, population density, elevation, and temperature were identified as the main contributors to the first Zika epidemic in Colombia. We also estimated the probability of Zika presence by municipality and week, and the results suggest that the disease circulated undetected by the surveillance system on many occasions. Our results offer insights into priority areas for public health interventions against emerging and re-emerging Aedes-borne diseases.
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Affiliation(s)
- Laís Picinini Freitas
- Université de Montréal, École de Santé Publique, Montreal, H3N 1X9, Canada.
- Centre de Recherche en Santé Publique, Montreal, H3N 1X9, Canada.
| | - Dirk Douwes-Schultz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, H3A 1G1, Canada.
| | - Alexandra M Schmidt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, H3A 1G1, Canada
| | - Brayan Ávila Monsalve
- Universidad Cooperativa de Colombia, Faculty of Medicine, Villavicencio, 500003, Colombia
| | - Jorge Emilio Salazar Flórez
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, 055450, Colombia
- Infectious and Chronic Diseases Study Group (GEINCRO), San Martín University Foundation, Medellín, 050031, Colombia
| | - César García-Balaguera
- Universidad Cooperativa de Colombia, Faculty of Medicine, Villavicencio, 500003, Colombia
| | - Berta N Restrepo
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, 055450, Colombia
| | | | - Mabel Carabali
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, H3A 1G1, Canada
| | - Kate Zinszer
- Université de Montréal, École de Santé Publique, Montreal, H3N 1X9, Canada
- Centre de Recherche en Santé Publique, Montreal, H3N 1X9, Canada
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2
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Memedovich A, Orr T, Hollis A, Salmon C, Hu J, Zinszer K, Williamson T, Beall RF. Social network risk factors and COVID-19 vaccination: A cross-sectional survey study. Vaccine 2024; 42:891-911. [PMID: 38238114 DOI: 10.1016/j.vaccine.2024.01.012] [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: 07/10/2023] [Revised: 11/10/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Social networks have an important impact on our health behaviours, including vaccination. People's vaccination beliefs tend to mirror those of their social network. As social networks are homogenous in many ways, we sought to determine in the context of COVID-19 which factors were most predictive of belonging to a mostly vaccinated or unvaccinated social group. METHODS We conducted a cross-sectional survey among Canadian residents in November and December 2021. Participants were asked about the vaccination status of their social networks their beliefs relating to COVID-19, and various sociodemographic factors. Respondents were split into three groups based on social network vaccination: low-, medium-, and high-risk. Chi-squared tests tested associations between factors and risk groups, and an ordinal logistic model was created to determine their direction and strength. RESULTS Most respondents (81.1 %) were classified as low risk (i.e., a mostly vaccinated social network) and few respondents (3.7 %) were classified as high-risk (i.e., an unvaccinated social group). Both the chi-square test (29.2 % difference between the low- and high- risk groups [1.8 % vs. 31.0 %], p < 0.001) and the ordinal logistic model (odds ratio between the low- and high-risk groups: 14.45, p < 0.01) found that respondents' perceptions of COVID-19 as a "not at all serious" risk to Canadians was the most powerful predictor of belonging to a predominantly unvaccinated social circle. The model also found that those in mostly unvaccinated social circles also more often reported severe COVID-19 symptoms (odds ratio between the low- and high-risk groups: 2.26, p < 0.05). CONCLUSION Perception of COVID-19 as a threat to others may signal communities with lower vaccination coverage and higher risk of severe outcomes. This may have implications for strategies to improve public outreach, messaging, and planning for downstream consequences of low intervention uptake.
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Affiliation(s)
- Ally Memedovich
- Department of Community Health Sciences, Cumming School of Medicine and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Taylor Orr
- Department of Community Health Sciences, Cumming School of Medicine and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Aidan Hollis
- Department of Economics, University of Calgary, 2500 University Dr. NW, Calgary, AB, Canada
| | - Charleen Salmon
- Department of Community Health Sciences, Cumming School of Medicine and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Jia Hu
- Department of Community Health Sciences, Cumming School of Medicine and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, QC, Canada; Centre for Public Health Research, University of Montreal, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada
| | - Reed F Beall
- Department of Community Health Sciences, Cumming School of Medicine and O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
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Sadoine ML, Zinszer K, Liu Y, Gachon P, Fournier M, Dueymes G, Dorsey G, Llerena A, Namuganga JF, Nasri B, Smargiassi A. Predicting malaria risk considering vector control interventions under climate change scenarios. Sci Rep 2024; 14:2430. [PMID: 38286803 PMCID: PMC10824718 DOI: 10.1038/s41598-024-52724-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: 07/07/2023] [Accepted: 01/23/2024] [Indexed: 01/31/2024] Open
Abstract
Many studies have projected malaria risks with climate change scenarios by modelling one or two environmental variables and without the consideration of malaria control interventions. We aimed to predict the risk of malaria with climate change considering the influence of rainfall, humidity, temperatures, vegetation, and vector control interventions (indoor residual spraying (IRS) and long-lasting insecticidal nets (LLIN)). We used negative binomial models based on weekly malaria data from six facility-based surveillance sites in Uganda from 2010-2018, to estimate associations between malaria, environmental variables and interventions, accounting for the non-linearity of environmental variables. Associations were applied to future climate scenarios to predict malaria distribution using an ensemble of Regional Climate Models under two Representative Concentration Pathways (RCP4.5 and RCP8.5). Predictions including interaction effects between environmental variables and interventions were also explored. The results showed upward trends in the annual malaria cases by 25% to 30% by 2050s in the absence of intervention but there was great variability in the predictions (historical vs RCP 4.5 medians [Min-Max]: 16,785 [9,902-74,382] vs 21,289 [11,796-70,606]). The combination of IRS and LLIN, IRS alone, and LLIN alone would contribute to reducing the malaria burden by 76%, 63% and 35% respectively. Similar conclusions were drawn from the predictions of the models with and without interactions between environmental factors and interventions, suggesting that the interactions have no added value for the predictions. The results highlight the need for maintaining vector control interventions for malaria prevention and control in the context of climate change given the potential public health and economic implications of increasing malaria in Uganda.
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Affiliation(s)
- Margaux L Sadoine
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada.
- Center for Public Health Research, Université de Montréal, Montreal, Quebec, Canada.
| | - Kate Zinszer
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Center for Public Health Research, Université de Montréal, Montreal, Quebec, Canada
| | - Ying Liu
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Center for Public Health Research, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Gachon
- ESCER (Étude et Simulation du Climat à l'Échelle Régionale) Centre, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Michel Fournier
- Department of Public Health, Montreal Regional, Montreal, Quebec, Canada
| | - Guillaume Dueymes
- ESCER (Étude et Simulation du Climat à l'Échelle Régionale) Centre, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Grant Dorsey
- University of California San Francisco, San Francisco, USA
| | - Ana Llerena
- Department of Earth and Atmospheric Sciences, Université du Québec à Montréal, Montreal, Quebec, Canada
| | | | - Bouchra Nasri
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Center for Public Health Research, Université de Montréal, Montreal, Quebec, Canada
| | - Audrey Smargiassi
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Center for Public Health Research, Université de Montréal, Montreal, Quebec, Canada
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Chabrol F, Traverson L, Hou R, Chotard L, Lucet JC, Peiffer-Smadja N, Bendjelloul G, Lescure FX, Yazdanpanah Y, Zinszer K, Ridde V. Adaptation and Response of a Major Parisian Referral Hospital to the COVID-19 Surge: A Qualitative Study. Health Syst Reform 2023; 9:2165429. [PMID: 36803567 DOI: 10.1080/23288604.2023.2165429] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Since the beginning of the COVID-19 pandemic, few studies have focused on crisis management of multiple services within one hospital over several waves of the pandemic. The purpose of this study was to provide an overview of the COVID-19 crisis response of a Parisian referral hospital which managed the first three COVID cases in France and to analyze its resilience capacities. Between March 2020 and June 2021, we conducted observations, semi-structured interviews, focus groups, and lessons learned workshops. Data analysis was supported by an original framework on health system resilience. Three configurations emerged from the empirical data: 1) reorganization of services and spaces; 2) management of professionals' and patients' contamination risk; and 3) mobilization of human resources and work adaptation. The hospital and its staff mitigated the effects of the pandemic by implementing multiple and varied strategies, which the staff perceived as having positive and/or negative consequences. We observed an unprecedented mobilization of the hospital and its staff to absorb the crisis. Often the mobilization fell on the shoulders of the professionals, adding to their exhaustion. Our study demonstrates the capacity of the hospital and its staff to absorb the COVID-19 shock by putting in place mechanisms for continuous adaptation. More time and insight will be needed to observe whether these strategies and adaptations will be sustainable over the coming months and years and to assess the overall transformative capacities of the hospital.
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Affiliation(s)
- Fanny Chabrol
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Renyou Hou
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Lisa Chotard
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Jean-Christophe Lucet
- Equipe de Prévention du Risque Infectieux, Hôpital Bichat Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Cité, Inserm, IAME, F-75006 Paris, France
| | - Nathan Peiffer-Smadja
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Cité, Inserm, IAME, F-75006 Paris, France
| | - Gisèle Bendjelloul
- Equipe de Prévention du Risque Infectieux, Hôpital Bichat Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François-Xavier Lescure
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Cité, Inserm, IAME, F-75006 Paris, France
| | - Yazdan Yazdanpanah
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Cité, Inserm, IAME, F-75006 Paris, France
| | - Kate Zinszer
- Ecole de Santé publique de l'Université de Montréal, Centre de recherche en santé publique, Université de Montréal, Québec, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
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5
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Gautier L, Gabet M, Duhoux A, Traverson L, Ridde V, Zinszer K, David PM. Supporting Reassigned Hospital Staff During the COVID-19 Pandemic in the Montreal Region: What Does it say About Leadership Styles? Can J Nurs Res 2023; 55:472-485. [PMID: 37587875 PMCID: PMC10619168 DOI: 10.1177/08445621231192044] [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] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Globally, the COVID-19 pandemic took a high toll on health human resources, especially in contexts where these resources were already fragile. In Quebec, to make up for the shortage of health human resources, and to contain the COVID-19 outbreaks in long-term care facilities, many hospital staff (including a majority of nurses) were sent to those facilities, with varying degrees of support. Building on the body of evidence linking leadership style and resilience, we conducted a qualitative comparative analysis of two hospitals in the Montreal Metropolitan Area, Quebec. We explored respondents' experience of psychosocial support tools provided to hospital staff reassigned to COVID-affected facilities. Data from 27 in-depth interviews with high- and mid-level managers, and front-line workers, was analyzed through the lens of leadership styles. Our findings highlighted how the design and implementation of support tools revealed major differences across the two hospitals' leadership styles (i.e., one hospital expressing leader-centered styles vs. the other expressing follower-centered leadership styles). The expression of these leadership styles was largely shaped by recent policies, notably a major political reform of 2015, which enforced more centralized decision-making. Our study offered additional empirical evidence that leadership styles fostering the recovery of health human resources may be a key indicator of successful response to crises.
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Affiliation(s)
- Lara Gautier
- School of Public Health, University of Montréal, Montréal, Canada
- Centre de recherche en santé publique (CReSP), University of Montréal and CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Canada
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Morgane Gabet
- School of Public Health, University of Montréal, Montréal, Canada
| | - Arnaud Duhoux
- Faculty of nursing, University of Montréal, Montréal, Canada
| | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006 Paris, France
| | - Kate Zinszer
- School of Public Health, University of Montréal, Montréal, Canada
- Centre de recherche en santé publique (CReSP), University of Montréal and CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Canada
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6
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Sadoine ML, Smargiassi A, Liu Y, Gachon P, Fournier M, Dueymes G, Namuganga JF, Dorsey G, Nasri B, Zinszer K. Differential Influence of Environmental Factors on Malaria Due to Vector Control Interventions in Uganda. Int J Environ Res Public Health 2023; 20:7042. [PMID: 37998273 PMCID: PMC10671539 DOI: 10.3390/ijerph20227042] [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] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Few studies have explored how vector control interventions may modify associations between environmental factors and malaria. METHODS We used weekly malaria cases reported from six public health facilities in Uganda. Environmental variables (temperature, rainfall, humidity, and vegetation) were extracted from remote sensing sources. The non-linearity of environmental variables was investigated, and negative binomial regression models were used to explore the influence of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) on associations between environmental factors and malaria incident cases for each site as well as pooled across the facilities, with or without considering the interaction between environmental variables and vector control interventions. RESULTS An average of 73.3 weekly malaria cases per site (range: 0-597) occurred between 2010 and 2018. From the pooled model, malaria risk related to environmental variables was reduced by about 35% with LLINs and 63% with IRS. Significant interactions were observed between some environmental variables and vector control interventions. There was site-specific variability in the shape of the environment-malaria risk relationship and in the influence of interventions (6 to 72% reduction in cases with LLINs and 43 to 74% with IRS). CONCLUSION The influence of vector control interventions on the malaria-environment relationship need to be considered at a local scale in order to efficiently guide control programs.
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Affiliation(s)
- Margaux L. Sadoine
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Center for Public Health Research, Université de Montréal, Montreal, QC H3N 1X9, Canada
| | - Audrey Smargiassi
- Center for Public Health Research, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Montreal, QC H3T 1A8, Canada
| | - Ying Liu
- Center for Public Health Research, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Department of Environmental and Occupational Health, School of Public Health, Université de Montréal, Montreal, QC H3T 1A8, Canada
| | - Philippe Gachon
- ESCER (Étude et Simulation du Climat à l’Échelle Régionale) Centre, Université du Québec à Montréal, Montreal, QC H2L 2C4, Canada
| | - Michel Fournier
- Montreal Regional Department of Public Health, Montreal, QC H2L 1M3, Canada
| | - Guillaume Dueymes
- ESCER (Étude et Simulation du Climat à l’Échelle Régionale) Centre, Université du Québec à Montréal, Montreal, QC H2L 2C4, Canada
| | | | - Grant Dorsey
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Bouchra Nasri
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Center for Public Health Research, Université de Montréal, Montreal, QC H3N 1X9, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC H3N 1X9, Canada
- Center for Public Health Research, Université de Montréal, Montreal, QC H3N 1X9, Canada
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7
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Ridde V, Coulibaly A, Touré L, Ba MF, Zinszer K, Bonnet E, Honda A. Financial issues in times of a COVID-19 pandemic in a tertiary hospital in Mali. Int J Health Plann Manage 2023; 38:1676-1693. [PMID: 37507357 DOI: 10.1002/hpm.3690] [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] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/28/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND This study examines how the functioning of healthcare providers during the COVID-19 pandemic was affected by the government financing response, which was shaped by existing healthcare financing systems. METHODS The study applied a single case study design at a tertiary hospital in Bamako during the 1st and 2nd waves of the COVID-19 pandemic. Data were gathered through 51 in-depth interviews with hospital staff, participatory observation, and reviewing media articles and hospital financial records. RESULTS The study revealed the disruptions experienced by hospital managers, human resources for health and patients in Mali during the early stages of the pandemic. While the government aimed to support universal access to COVID-19-related services, efforts were undermined by issues associated with complex public financing management procedures. The hospital experienced long delays in transferring government funds. The hospital suffered a decrease in revenue during the early stages of the pandemic. Government budgets were not effectively used because of complex, non-agile procedures that could not adapt to the emergency. The challenges faced by the hospitals led to the delays in the staff payments of salaries and promised bonuses, which created potential for unfair treatment of patients. Excluding some COVID-19 related items from the government funded benefit package created a financial burden on people receiving services. The managerial challenges experienced in the study hospital during the first wave continued in the second wave. CONCLUSIONS Pre-existent issues in healthcare financing and governance constrained the effective management of COVID-19-related services and created confusion at the front line of healthcare service delivery.
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Affiliation(s)
- Valéry Ridde
- UMR 196, CEPED, The French National Research Institute for Sustainable (IRD), Université Paris Cité, Paris, France
- Institut de Santé et Développement (ISED), Université Cheikh Anta Diop, Dakar, Senegal
| | - Abdourahmane Coulibaly
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies, Bamako, Mali
| | | | - Mouhamadou Faly Ba
- Institut de Santé et Développement (ISED), Université Cheikh Anta Diop, Dakar, Senegal
| | - Kate Zinszer
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de recherche en santé publique (CRePS), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Emmanuel Bonnet
- UMR 215 Prodig, French National Research Institute for Sustainable (IRD), Aubervilliers, France
| | - Ayako Honda
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, Tokyo, Japan
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8
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Abuzerr S, Zinszer K. Computer-aided diagnostic accuracy of pulmonary tuberculosis on chest radiography among lower respiratory tract symptoms patients. Front Public Health 2023; 11:1254658. [PMID: 37965525 PMCID: PMC10641698 DOI: 10.3389/fpubh.2023.1254658] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Even though the Gaza Strip is a low pulmonary tuberculosis (TB) burden region, it is well-known that TB is primarily a socioeconomic problem associated with overcrowding, poor hygiene, a lack of fresh water, and limited access to healthcare, which is the typical case in the Gaza Strip. Therefore, this study aimed at assessing the accuracy of the automatic software computer-aided detection for tuberculosis (CAD4TB) in diagnosing pulmonary TB on chest radiography and compare the CAD4TB software reading with the results of geneXpert. Using a census sampling method, the study was conducted in radiology departments in the Gaza Strip hospitals between 1 December 2022 and 31 March 2023. A digital X-ray, printer, and online X-ray system backed by CAD4TBv6 software were used to screen patients with lower respiratory tract symptoms. GeneXpert analysis was performed for all patients having a score > 40. A total of 1,237 patients presenting with lower respiratory tract symptoms participated in this current study. Chest X-ray readings showed that 7.8% (n = 96) were presumptive for TB. The CAD4TBv6 scores showed that 11.8% (n = 146) of recruited patients were presumptive for TB. GeneXpert testing on sputum samples showed that 6.2% (n = 77) of those with a score > 40 on CAD4TB were positive for pulmonary TB. Significant differences were found in chest X-ray readings, CAD4TBv6 scores, and GeneXpert results among sociodemographic and health status variables (P-value < 0.05). The study showed that the incidence rate of TB in the Gaza Strip is 3.5 per 100,000 population in the Gaza strip. The sensitivity of the CAD4TBv6 score and the symptomatic review for tuberculosis with a threshold score of >40 is 80.2%, and the specificity is 94.0%. The positive Likelihood Ratio is 13.3%, Negative Likelihood Ratio is 0.2 with 7.8% prevalence. Positive Predictive Value is 52.7%, Negative Predictive Value is 98.3%, and accuracy is 92.9%. In a resource-limited country with a high burden of neglected disease, combining chest X-ray readings by CAD4TB and symptomatology is extremely valuable for screening a population at risk. CAD4TB is noticeably more efficient than other methods for TB screening and early diagnosis in people who would otherwise go undetected.
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Affiliation(s)
- Samer Abuzerr
- Department of Medical Sciences, University College of Science and Technology, Gaza, Palestine
| | - Kate Zinszer
- School of Public Health, Department of Social and Preventive Medicine, University of Montreal, Montréal, QC, Canada
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9
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Gagnon-Dufresne MC, Gautier L, Beaujoin C, Boivin P, Coulibaly A, Richard Z, Gomes de Medeiros S, Dutra Da Nóbrega RE, de Araujo Oliveira SR, Cloos P, Chabrol F, Ridde V, Zinszer K. Did the design and planning of testing and contact tracing interventions for COVID-19 consider social inequalities in health? A multiple case study from Brazil, Canada, France & Mali. Soc Sci Med 2023; 335:116230. [PMID: 37716184 DOI: 10.1016/j.socscimed.2023.116230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/18/2023]
Abstract
The COVID-19 pandemic has led to an unprecedented global crisis. It has exposed and exacerbated weaknesses in public health systems worldwide, particularly with regards to reaching the most vulnerable populations, disproportionately impacted by the pandemic. The objective of our study was to examine whether and how social inequalities in health (SIH) were considered in the design and planning of public health responses to COVID-19 in jurisdictions of Brazil, Canada, France, and Mali. This article reports on a qualitative multiple case study of testing and contact tracing interventions in regions with high COVID-19 incidence in each country, namely: Manaus (Brazil), Montréal (Canada), Île-de-France (France), and Bamako (Mali). We conducted interviews with 108 key informants involved in these interventions in the four jurisdictions, focusing on the first and second waves of the pandemic. We analyzed our data thematically using a theoretical bricolage framework. Our analysis suggests that the lack of a common understanding of SIH among all actors involved and the sense of urgency brought by the pandemic eclipsed the prioritization of SIH in the initial responses. The pandemic increased intersectoral collaboration, but decision-making power was often unequal between Ministries of Health and other actors in each jurisdiction. Various adaptations to COVID-19 interventions were implemented to reach certain population groups, therefore improving the accessibility, availability, and acceptability of testing and contact tracing. Our study contributes to identifying lessons learned from the current pandemic, namely that the ways in which SIH are understood shape how interventions are planned; that having clear guidelines on how to integrate SIH into public health interventions could lead to more inclusive pandemic responses; that for intersectoral collaboration to be fruitful, there needs to be sufficient resources and equitable decision-making power between partners; and that interventions must be flexible to respond to emerging needs while considering long-standing structural inequalities.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada.
| | - Lara Gautier
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada.
| | - Camille Beaujoin
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada.
| | - Pauline Boivin
- Unité de Recherche en Sciences Sociales Miseli, Ilot N°17, Cité El Farako, P.O. Box E 5448, Bamako, Mali.
| | - Abdourahmane Coulibaly
- Unité de Recherche en Sciences Sociales Miseli, Ilot N°17, Cité El Farako, P.O. Box E 5448, Bamako, Mali.
| | - Zoé Richard
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Institut National de La Santé et de La Recherche Médicale (INSERM), Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Stéphanie Gomes de Medeiros
- Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife PE 50670-901, Brazil.
| | - Raylson Emanuel Dutra Da Nóbrega
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco, Av. Prof. Moraes Rego - Cidade Universitária, Recife PE 50740-465, Brazil.
| | - Sydia Rosana de Araujo Oliveira
- Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Federal University of Pernambuco, Av. Prof. Moraes Rego - Cidade Universitária, Recife PE 50740-465, Brazil.
| | - Patrick Cloos
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada; School of Social Work, University of Montréal, 3150 Rue Jean-Brillant, Montréal, QC, H3T 1N8, Canada.
| | - Fanny Chabrol
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Institut National de La Santé et de La Recherche Médicale (INSERM), Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Valéry Ridde
- Université Paris Cité, Institut de Recherche pour le Développement (IRD), Institut National de La Santé et de La Recherche Médicale (INSERM), Centre Population et Développement (CEPED), 45 Rue des Saints-Pères, F-75006, Paris, France.
| | - Kate Zinszer
- School of Public Health, University of Montréal, 7101 Avenue Du Parc, Montréal, QC, H3N 1X9, Canada; Centre de Recherche en Santé Publique (CReSP), 1301 Rue Sherbrooke Est, Montréal, QC, H3L 1M3, Canada.
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Zhang Y, Zahreddine M, Abreu K, Dantas MA, Charland K, Pierce L, Ridde V, Zinszer K. Knowledge, attitude and practice (KAP) and risk factors on dengue fever among children in Brazil, Fortaleza: A cross-sectional study. PLoS Negl Trop Dis 2023; 17:e0011110. [PMID: 37747907 PMCID: PMC10553826 DOI: 10.1371/journal.pntd.0011110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 10/05/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Dengue fever is a mosquito-borne viral disease that is associated with four serotypes of the dengue virus. Children are vulnerable to infection with the dengue virus, particularly those who have been previously infected with a different dengue serotype. Sufficient knowledge, positive attitudes, and proper practices (KAP) are essential for dengue prevention and control. This study aims to estimate the dengue seropositivity for study participants and to examine the association between households' dengue-related knowledge, attitudes, and practices (KAP), and children's risk of dengue seropositivity, while accounting for socioeconomic and demographic differences in Brazil. METHODOLOGY/PRINCIPAL FINDINGS This analysis was based on a cross-sectional study from Fortaleza, Brazil between November 2019, and February 2020. There were 392 households and 483 participant children who provided a sample of sufficient quality for serological analysis. The main exposure was a household's dengue-related knowledge, attitudes, and practices, assessed through a questionnaire to construct a composite KAP score categorized into three levels: low, moderate, and high. The main outcome is dengue immunoglobulin G(IgG) antibodies, collected using dried blood spots and assessed with Panbio Dengue IgG indirect ELISA (enzyme-linked immunosorbent assays) test commercial kits. The estimated crude dengue seroprevalence among participating children (n = 483) was 25%. Five percent of households (n = 20) achieved a score over 75% for KAP, sixty-nine percent of households (n = 271) scored between 50% and 75%, and twenty-six percent of households (n = 101) scored lower than 50%. Each KAP domain was significantly and positively associated with the others. The mean percentage scores for the three domains are 74%, 63%, and 39% respectively. We found high household KAP scores were associated with an increased adjusted relative risk (aRR) of seropositivity (aRR: 2.11, 95% CI: 1.11-4.01, p = 0.023). Household adult respondents' education level of elementary school or higher was negatively associated with children's risk of being seropositive (aRR: 0.65, 95% CI: 0.48-0.87, p = 0.005). The risk of seropositivity in older children (6-12 years old) was over 6 times that of younger children (2-5 years old) (aRR: 6.08, 95% CI: 3.47-10.64, p<0.001). Children living in households with sealed water tanks or no water storage had a lower risk of being seropositive (aRR: 0.73, 95% CI: 0.54-0.98, p = 0.035). CONCLUSIONS/SIGNIFICANCE Our results provide insight into the prevalence of dengue seropositivity in Fortaleza, Brazil in children, and certain demographic and socioeconomic characteristics associated with children's risk of being seropositive. They also suggest that KAP may not identify those more at-risk for dengue, although understanding and enhancing households' KAP is crucial for effective community dengue control and prevention initiatives.
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Affiliation(s)
- Yang Zhang
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Monica Zahreddine
- Center for Public Health Research, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Katia Charland
- Center for Public Health Research, University of Montreal, Montreal, Quebec, Canada
| | - Laura Pierce
- Center for Public Health Research, University of Montreal, Montreal, Quebec, Canada
| | - Valéry Ridde
- Institute for Research on Sustainable Development, CEPED (IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Kate Zinszer
- Center for Public Health Research, University of Montreal, Montreal, Quebec, Canada
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
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McKinnon B, Abalovi K, Fortin G, Parvez M, Dalal S, Bouabid R, Jasmin D, Zéphrin M, Gupta N, Hasan AT, Andog-Naba Sebastien A, Taheem B, Dubé È, Tuong Nguyen C, Quach C, Vandermorris A, Zinszer K. Perspectives on COVID-19 Vaccination and Vaccine Passports in a Diverse Urban Adolescent Population: A Youth Participatory Mixed Methods Study. J Adolesc Health 2023; 73:527-535. [PMID: 37294252 PMCID: PMC10150197 DOI: 10.1016/j.jadohealth.2023.04.013] [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: 09/20/2022] [Revised: 03/02/2023] [Accepted: 04/11/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Disparities in youth COVID-19 vaccine acceptance and uptake have been documented in several countries, yet few studies have explored the attitudes and perceptions underlying vaccine-related decision-making among adolescent populations with unique sociocultural, environmental, and/or structural contexts that may influence vaccine uptake. METHODS This study used data from surveys and semistructured interviews collected between January and March 2022 as part of an ongoing community-based research project in two ethnoculturally diverse, lower income neighborhoods of Montreal, Canada. Youth researchers designed and conducted interviews with unvaccinated adolescents, and thematic analysis was employed to explore attitudes and perceptions underlying vaccine-related decisions and opinions about vaccine passports. Survey data were used to describe sociodemographic and psychological determinants of COVID-19 vaccination. RESULTS Among 315 survey participants aged 14-17 years, most (74%) were fully vaccinated against COVID-19. Prevalence ranged from 57% among Black adolescents to 91% among South and/or Southeast Asian adolescents (34% difference, 95% confidence interval: 20-49). Qualitative and quantitative findings highlighted several misconceptions about the safety, effectiveness, and necessity of COVID-19 vaccines and adolescents' desire for trusted sources of information to address their concerns. Vaccine passports likely increased uptake, yet adolescents were strongly resistant to the policy, and for some, it may have fueled distrust of government and scientific institutions. DISCUSSION Strategies that increase the trustworthiness of institutions and foster genuine partnership with underserved youth may improve vaccine confidence and help ensure an effective, proequity recovery from COVID-19.
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Affiliation(s)
- Britt McKinnon
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Krystelle Abalovi
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada
| | - Geneviève Fortin
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; School of Public Health, University of Montreal, Montréal, Québec, Canada
| | - Maryam Parvez
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Sanya Dalal
- School of Population and Global Health, McGill University, Montréal, Québec, Canada
| | - Rania Bouabid
- Calixa-Lavallée Secondary School, Montréal-Nord, Québec, Canada
| | - Djunah Jasmin
- Henri-Bourassa Secondary School, Montréal-Nord, Québec, Canada
| | | | - Nandini Gupta
- Lucien-Pagé Secondary School, Montréal, Québec, Canada
| | | | | | - Binal Taheem
- Lucien-Pagé Secondary School, Montréal, Québec, Canada
| | - Ève Dubé
- Research Centre of the CHU of Québec, Laval University, Québec, Québec, Canada
| | - Cat Tuong Nguyen
- School of Public Health, University of Montreal, Montréal, Québec, Canada
| | - Caroline Quach
- Department of Microbiology, Infectiology and Immunology, University of Montreal, Montréal, Québec, Canada
| | - Ashley Vandermorris
- Division of Adolescent Medicine, Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Kate Zinszer
- Centre for Public Health Research, University of Montreal, Montréal, Québec, Canada; School of Public Health, University of Montreal, Montréal, Québec, Canada
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Fortin G, Saucier A, Munoz-Bertrand M, Yuan M, Ante Z, Narasiah L, Zinszer K. Portrait of Montréal healthcare workers infected with SARS-CoV-2 during the first wave of the pandemic: a cross-sectional study. Can J Public Health 2023; 114:534-546. [PMID: 37410364 PMCID: PMC10351277 DOI: 10.17269/s41997-023-00789-y] [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: 08/12/2022] [Accepted: 05/23/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES During the first wave of COVID-19 in Québec, healthcare workers (HCWs) represented 25% of the cases in Montréal. A study was conducted to describe SARS-CoV-2-infected HCWs in Montréal, and certain workplace and household characteristics. Secondary objectives included estimating the associations between having had access to personal protective equipment (PPE) and training, and following self-isolation recommendations, and certain sociodemographic and workplace characteristics. METHODS A cross-sectional study was conducted, based on a stratified random sample, among Montréal HCWs who tested positive for SARS-CoV-2 between March and July 2020. A total of 370 participants answered a telephone-administered questionnaire. Descriptive statistics were conducted, followed by log binomial regressions to estimate the associations. RESULTS Study participants were mostly female (74%), born outside of Canada (65%), and identified as Black, Indigenous, and People of Colour (BIPOC; 63%). In terms of healthcare positions, most were orderlies (40%) or registered nurses (20%). Half (52%) of the participants reported having had insufficient access to PPE and 30% reported having received no training related to SARS-CoV-2 infection prevention, with large proportions being BIPOC women. Working evening or night shifts decreased chances of having had sufficient access to PPE (OR 0.50; 0.30-0.83). CONCLUSION This study describes the profile of the HCWs who were infected during the first wave of the pandemic in Montréal. Recommendations include collecting comprehensive sociodemographic data on SARS-CoV-2 infections and ensuring equitable access to infection prevention and control training and PPE during health crises, particularly those at highest risk of exposure.
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Affiliation(s)
- Geneviève Fortin
- École de Santé Publique, Université de Montréal, Montréal, QC, Canada.
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada.
| | - Adrien Saucier
- École de Santé Publique, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada
| | - Marie Munoz-Bertrand
- Direction Régionale de Santé Publique de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Mengru Yuan
- École de Santé Publique, Université de Montréal, Montréal, QC, Canada
| | | | - Lavanya Narasiah
- Direction Régionale de Santé Publique de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Kate Zinszer
- École de Santé Publique, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada
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Fortin G, Gagnon-Dufresne MC, Bunkeddeko K, Muwereza J, Zinszer K. Barriers to family planning through structural health vulnerabilities: findings from case studies from rural Uganda. Cult Health Sex 2023; 25:1070-1083. [PMID: 36153729 DOI: 10.1080/13691058.2022.2122571] [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: 09/18/2021] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
The burden of maternal mortality in sub-Saharan Africa is the highest in the world. As high fertility rates present an increased risk to women's health, programmes and services have been put in place to increase access to family planning. Several studies have identified sociocultural factors as limiting access to family planning, including male resistance and women's low decision-making power. However, these studies have often used a behavioural approach that anchors barriers to access in women's attitudes or motivations. In 2019, a qualitative evaluation of a family planning programme using a behavioural approach was conducted in rural Uganda, focusing on women's attitudes and unmet needs. With hindsight, we realised that our evaluation was insufficient to adequately capture barriers that extend beyond women's motivations. This paper shares three case studies that we analysed using a structural health vulnerabilities approach. Our analysis highlights political, economic, social and cultural structures that can impede access to family planning. Using a structural health vulnerabilities approach, we identify structural barriers which have their roots in the local realities women face and propose context-specific structural recommendations. Finally, we contrast our initial results with findings the case studies presented to highlight the relevance of taking structural vulnerabilities into account in future family planning programme evaluation and women's sexual and reproductive health studies.
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Affiliation(s)
- Geneviève Fortin
- École de santé publique de l'Université de Montréal (ESPUM), University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP) (Center for Public Health Research), Montreal, QC, Canada
| | - Marie-Catherine Gagnon-Dufresne
- École de santé publique de l'Université de Montréal (ESPUM), University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP) (Center for Public Health Research), Montreal, QC, Canada
| | | | | | - Kate Zinszer
- École de santé publique de l'Université de Montréal (ESPUM), University of Montreal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP) (Center for Public Health Research), Montreal, QC, Canada
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Memedovich A, Farkas B, Hollis A, Salmon C, Hu J, Zinszer K, Williamson T, Beall RF. COVID-19 Vaccine's Speed to Market and Vaccine Hesitancy: A Cross-Sectional Survey Study. Healthc Policy 2023; 19:99-113. [PMID: 37695711 PMCID: PMC10519340 DOI: 10.12927/hcpol.2023.27153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Background This paper aims to assess the extent to which the COVID-19 vaccine's speed to market affected Canadian residents' decision to remain unvaccinated. Method A cross-sectional survey conducted in late 2021 asked participants whether they had received the vaccine and their reasons for abstaining. Results Of the 2,712 participants who completed the survey, 8.9% remained unvaccinated. Unvaccinated respondents who selected "They made the vaccine too fast" (59.8%), were significantly more likely to identify as white, believe that the COVID-19 pandemic was not serious and have an unvaccinated social circle. Conclusion Should the COVID-19 vaccine rapid regulatory process be expanded, more patients may refuse treatment than if traditional timelines are followed.
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Affiliation(s)
- Ally Memedovich
- Research Analyst Department of Community Health Sciences Cumming School of Medicine University of Calgary Research Analyst O'Brien Institute for Public Health University of Calgary Calgary, AB
| | - Brenlea Farkas
- Senior Research Associate Department of Community Health Sciences Cumming School of Medicine University of Calgary Senior Research Associate O'Brien Institute for Public Health University of Calgary Calgary, AB
| | - Aidan Hollis
- Professor Department of Economics University of Calgary Calgary, AB
| | - Charleen Salmon
- Research Analyst Department of Community Health Sciences Cumming School of Medicine University of Calgary Research Analyst O'Brien Institute of Public Health University of Calgary Calgary, AB
| | - Jia Hu
- Medical Officer of Health Alberta Health Services Edmonton, AB
| | - Kate Zinszer
- Associate Professor Department of Social and Preventive Medicine Université de Montréal, Montreal, QC
| | - Tyler Williamson
- Associate Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Associate Professor O'Brien Institute of Public Health University of Calgary Calgary, AB
| | - Reed F Beall
- Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Assistant Professor O'Brien Institute of Public Health University of Calgary Calgary, AB
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Zinszer K, Charland K, Pierce L, Saucier A, Hamelin M, Da Torre MB, Carbonneau J, Nguyen CT, De Serres G, Papenburg J, Boivin G, Quach C. Infection-induced seroconversion and seroprevalence of SARS-CoV-2 among a cohort of children and youth in Montreal, Canada. Influenza Other Respir Viruses 2023; 17:e13186. [PMID: 37638094 PMCID: PMC10457549 DOI: 10.1111/irv.13186] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
The EnCORE study is a prospective serology study of SARS-CoV-2 in a cohort of children from Montreal, Canada. Based on data from our fourth round of data collection (May-October 2022), we estimated SARS-CoV-2 seroprevalence and seroconversion. Using multivariable regression, we identified factors associated with seroconversion. Our results show that previously seronegative children were approximately 9-12 times more likely to seroconvert during the early Omicron-dominant period compared to pre-Omicron rounds. Unlike the pre-Omicron rounds, the adjusted rate of seroconversion among 2- to 4-year-olds was higher than older age groups. As seen previously, higher seroconversion rates were associated with ethnic/racial minority status.
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Affiliation(s)
- Kate Zinszer
- School of Public HealthUniversity of MontrealMontrealQuebecCanada
- Centre for Public Health ResearchMontrealQuebecCanada
| | | | - Laura Pierce
- Centre for Public Health ResearchMontrealQuebecCanada
| | - Adrien Saucier
- School of Public HealthUniversity of MontrealMontrealQuebecCanada
- Centre for Public Health ResearchMontrealQuebecCanada
| | | | - Margot Barbosa Da Torre
- School of Public HealthUniversity of MontrealMontrealQuebecCanada
- Centre for Public Health ResearchMontrealQuebecCanada
| | - Julie Carbonneau
- Research Centre of Quebec‐Université LavalQuebec CityQuebecCanada
| | - Cat Tuong Nguyen
- Ministère de la santé et des services sociauxQuebec CityQuebecCanada
| | - Gaston De Serres
- National Institute of Public Health of QuebecQuebec CityQuebecCanada
| | - Jesse Papenburg
- Montreal Children's Hospital of the McGill University Health CentreMontrealQuebecCanada
| | - Guy Boivin
- Research Centre of Quebec‐Université LavalQuebec CityQuebecCanada
| | - Caroline Quach
- School of Public HealthUniversity of MontrealMontrealQuebecCanada
- Research Centre of the Sainte‐Justine University HospitalMontrealQuebecCanada
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David PM, Gabet M, Duhoux A, Traverson L, Ridde V, Zinszer K, Gautier L. Adapting Hospital Work During COVID-19 in Quebec (Canada). Health Syst Reform 2023; 9:2200566. [PMID: 37071844 DOI: 10.1080/23288604.2023.2200566] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Among hospital responses to the COVID19 pandemic worldwide, service reorganization and staff reassignment have been some of the most prominent ways of adapting hospital work to the expected influx of patients. In this article, we examine work reorganization induced by the pandemic by identifying the operational strategies implemented by two hospitals and their staff to contend with the crisis and then analyzing the implications of those strategies. We base our description and analysis on two hospital case studies in Quebec. We used a multiple case study approach, wherein each hospital is considered a unique case. In both cases, work adaptation through staff reassignment was one of the critical measures undertaken to ensure absorption of the influx of patients into the hospitals. Our results showed that this general strategy was designed and applied differently in the two cases. More specifically, the reassignment strategies revealed numerous healthcare resource disparities not only between health territories, but also between different types of facilities within those territories. Comparing the two hospitals' adaptation strategies showed that past reforms in Quebec determined what these reorganizations could achieve, as well as how they would affect workers and the meaning they gave to their work.
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Affiliation(s)
| | - Morgane Gabet
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Kate Zinszer
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Lara Gautier
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
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17
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Gautier L, Noda S, Chabrol F, David PM, Duhoux A, Hou R, Rosana de Araújo Oliveira S, Traverson L, Zinszer K, Ridde V. Hospital Governance During the COVID-19 Pandemic: A Multiple-Country Case Study. Health Syst Reform 2023; 9:2173551. [PMID: 37253204 DOI: 10.1080/23288604.2023.2173551] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/24/2023] [Indexed: 06/01/2023] Open
Abstract
In response to the disruptions caused by COVID-19, hospitals around the world proactively or reactively developed and/or re-organized their governance structures to manage the COVID-19 response. Hospitals' governance played a crucial role in their ability to reorganize and respond to the pressing needs of their staff. We discuss and compare six hospital cases from four countries on different continents: Brazil, Canada, France, and Japan. Our study examined how governance strategies (e.g., special task forces, communications management tools, etc.) were perceived by hospital staff. Key findings from a total of 177 qualitative interviews with diverse hospital stakeholders were analyzed using three categories drawn from the European Observatory on Health Systems and Policies framework on health systems resilience during the COVID-19 pandemic: 1) delivering a clear and timely COVID-19 response strategy; 2) coordinating effectively within (horizontally) and across (vertically) levels of decision-making; and 3) communicating clearly and transparently with the hospital's diverse stakeholders. Our study gleaned rich accounts for these three categories, highlighting significant variations across settings. These variations were primarily determined by the hospitals' environment prior to the COVID-19 crisis, namely whether there already existed a culture of managerial openness (including spaces for social interactions among hospital staff) and whether preparedness planning and training had been routinely integrated into their activities.
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Affiliation(s)
- Lara Gautier
- School of Public Health, Université de Montréal, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal, and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Shinichiro Noda
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fanny Chabrol
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | | | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | - Renyou Hou
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | | | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Kate Zinszer
- School of Public Health, Université de Montréal, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal, and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
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de Araújo Oliveira SR, Cazarin G, Soares Sampaio A, Ribeiro de Vasconcelos AL, Furtado B, Gomes de Medeiros S, Correia Paes Zacarias A, Reis Andrade AC, Paz de Sousa KM, Zinszer K, Ridde V. Potential Strengths and Weaknesses in Hospital Resilience in the Context of the COVID-19 Pandemic in Brazil: A Case Study. Health Syst Reform 2023; 9:2177242. [PMID: 37036130 DOI: 10.1080/23288604.2023.2177242] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
The analysis of hospital resilience is essential in understanding how health services prepared for and responded to sudden shocks and unexpected challenges in the COVID-19 health crisis. This study aimed to analyze the resilience of a referral hospital in the state of Pernambuco, Brazil, in the context of the COVID-19 pandemic. The main theoretical approach based on resilience is the system's capacity to maintain essential functions and to absorb, adapt, and transform in the face of unprecedented or unexpected changes. A single case study approach was used to identify the strengths and weaknesses of this response capacity. Data triangulation was employed. Data were collected from April (beginning of case discharges) to October 2020 (decrease in the moving average of cases in 2020). A content analysis was then conducted. Data were analyzed in relation to context, effects, strategies, and impacts in facing the disruptions caused by the pandemic. The results indicated the occurrence of four configurations mostly favorable to hospital resilience during the study period. Among the main strengths were: injection of financial resources; implementation of new hospital protocols; formation of a support network; equipping and continuing education of professionals; and proactive leadership. Weaknesses found in the analysis included: initial insufficiency of personal protective equipment and confirmatory tests; difficulties in restructuring work schedules; increasing illness among professionals; stress generated by constant changes and work overload; sense of discrimination for being a health professional; lack of knowledge about the clinical management of the disease; and the reduction of non-COVID assistance services.
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Affiliation(s)
| | - Gisele Cazarin
- Public Health Department, Instituto Aggeu Magalhães, Fiocruz, Pernambuco, Brazil
| | | | | | - Betise Furtado
- Public Health Department, University of Pernambuco, Nossa Senhora das Graças Nursing School, FENSG/UPE, FOP/UPE, Pernambuco, Brazil
| | | | | | | | | | - Kate Zinszer
- Public Health Department, University of Montreal, Montreal, Quebec, Canada
| | - Valéry Ridde
- Public Health Department, Université Paris Cité, IRD, Inserm, Ceped, Paris, France
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Gabet M, Duhoux A, Ridde V, Zinszer K, Gautier L, David PM. How Did an Integrated Health and Social Services Center in the Quebec Province Respond to the COVID-19 Pandemic? A Qualitative Case Study. Health Syst Reform 2023; 9:2186824. [PMID: 37000982 DOI: 10.1080/23288604.2023.2186824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
During the first and second waves of the pandemic, Quebec was among the Canadian provinces with the highest COVID-19 mortality rates. Facing particularly large COVID-19 outbreaks in its facilities, an integrated health and social services center in the province of Quebec (Canada), developed resilience strategies. To explore these diverse responses to the crisis, we conducted a case study analysis of a Quebec integrated health and social services center, building on a conceptualization of resilience strategies using "configurations" of effects, strategies, and impacts. Qualitative data from 14 indepth interviews conducted in the summer and fall of 2020 with managers and frontline practitioners were analyzed through the lens of situations of "anticipation," "reaction," or "inaction." The findings were discussed in three results dissemination workshops, two with practitioners and one with managers, to discern lessons they learned. Three major configurations emerged: 1) reorganization of services and spaces to accommodate more COVID-19 patients; 2) management of contamination risks for patients and professionals; and 3) management of personal protective equipment (PPE), supplies, and medications. Within these configurations, the responses to the crisis were strongly shaped by the 2015 health care system reforms in Quebec and were constrained by organizational challenges that included a centralized model of governance, a history of substantial budget cuts to longterm care facilities, and a systematic lack of human resources.
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Ridde V, Traverson L, Zinszer K. Hospital Resilience to the COVID-19 Pandemic in Five Countries: A Multiple Case Study. Health Syst Reform 2023; 9:2242112. [PMID: 37652669 DOI: 10.1080/23288604.2023.2242112] [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] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Since the beginning of the pandemic, hospitals have been central to the COVID-19 response, often experiencing severe financial, material, and human constraints. In this special issue, we present some of the findings of the HoSPiCOVID research project. One of its main objectives was to compare hospital responses to the first and second waves of the COVID-19 pandemic in Brazil, Canada, France, Japan, and Mali. Studying and comparing how nine different hospitals coped with the pandemic in terms of preparedness and response allowed us to: 1) identify strengths and weaknesses of their responses, including challenges for hospital professionals; and 2) produce lessons learned, using a systematic approach to reflect and analyze their potential of resilience to the crisis. In the five countries, research teams conducted in-depth qualitative studies focused on nine large hospitals, using observation sessions, semistructured interviews with hospital professionals, and lessons learned workshops. The empirical work was supported by an original analytical framework on hospital resilience and a heuristic tool focused on configurations. The studies demonstrate that the hospitals were able to absorb and/or adapt to the crisis by deploying different coping mechanisms, which often required extensive involvement of hospital professionals. More extended study periods would be needed to assess the sustainability of these coping mechanisms and discern whether they have transformative potential. These international comparisons of hospital resilience, based on studies of contrasting contexts and epidemiological situations, allowed researchers to identify lessons learned to support hospital decision-makers in thinking more deeply about managing future health crises.
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Affiliation(s)
- Valéry Ridde
- Université Paris Cité, IRD, Ceped, Paris, France
- Institut de Santé et Développement (ISED), Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Kate Zinszer
- School of Public Health (ESPUM), Université de Montréal, Montreal, Quebec, Canada
- Public Health Research Centre (CReSP), Université de Montréal, and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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Hou R, Traverson L, Chabrol F, Gautier L, de Araújo Oliveira SR, David PM, Lucet JC, Zinszer K, Ridde V. Communication and Information Strategies Implemented by Four Hospitals in Brazil, Canada, and France to Deal with COVID-19 Healthcare-Associated Infections. Health Syst Reform 2023; 9:2223812. [PMID: 37428514 DOI: 10.1080/23288604.2023.2223812] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
During the COVID-19 pandemic outbreak, COVID-19 healthcare-associated infections (HAI) and risk management became major challenges facing hospitals. Using evidence from a research project, this commentary presents: 1) various communication and information strategies implemented by four hospitals and their staff in Brazil, Canada and France to reduce the risks of COVID-19 HAIs, and how they were perceived by hospital staff; 2) the flaws in communication in the hospitals; and 3) a proposed agenda for research on and action to improve institutional communications for future pandemics. By analyzing "top-down" strategies at the organizational level and spontaneous strategies initiated by and between professionals, this study shows that during the first waves of the pandemic, reliable information and clear communication about guidelines and health protocols' changes can help alleviate fears among staff and avoid misapplication of protocols, thereby reducing infection risks. There was a lack of a "bottom-up" communication channel, while, when making decisions, it is crucial to listen to and fully take into account staff's voices, experiences, and feelings. More balanced communication between hospital administrators and staff could strengthen team cohesion and lead to better enforcement of protocols, which in turn will reduce the risk of contamination, alleviate the potential impacts on staff health, and improve the quality of care provided to patients.
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Affiliation(s)
- Renyou Hou
- Laboratoire d'ethnologie et de sociologie comparative (LESC), Université Paris Nanterre, CNRS, Nanterre, France
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Fanny Chabrol
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Lara Gautier
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | | | | | - Jean-Christophe Lucet
- Infection Control Unit, Assistance Publique - Hôpitaux de Paris, Hôpital Bichat - Claude-Bernard, Paris, France
- Infections, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, Université Paris Cité, Paris, France
| | - Kate Zinszer
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
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Dagenais C, Kielende M, Coulibaly A, Gautier L, David PM, Peiffer-Smadja N, Honda A, de Araújo Oliveira SR, Traverson L, Zinszer K, Ridde V. Lessons Learned from Field Experiences on Hospitals' Resilience to the COVID-19 Pandemic: A Systematic Approach. Health Syst Reform 2023; 9:2231644. [PMID: 37470503 DOI: 10.1080/23288604.2023.2231644] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
In this concluding article of the special issue, we examine lessons learned from hospitals' resilience to the COVID-19 pandemic in Brazil, Canada, France, Japan, and Mali. A quality lesson learned (QLL) results from a systematic process of collecting, compiling, and analyzing data derived ideally from sustained effort over the life of a research project and reflecting both positive and negative experiences. To produce QLLs as part of this research project, a guide to their development was drafted. The systematic approach we adopted to formulate quality lessons, while certainly complex, took into account the challenges faced by the different stakeholders involved in the fight against the COVID-19 pandemic. Here we present a comparative analysis of the lessons learned by hospitals and their staff with regard to four common themes that were the subject of empirical analyses: 1) infrastructure reorganization; 2) human resources management; 3) prevention and control of infection risk; and 4) logistics and supply. The lessons learned from the resilience of the hospitals included in this research indicate several factors to consider in preparing for a health crisis: 1) strengthening the coordination and leadership capacities of hospital managers and health authorities; 2) improving communication strategies; 3) strengthening organizational capacity; and 4) adapting resources and strategies, including for procurement and infection risk management.
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Affiliation(s)
- Christian Dagenais
- Department of Psychology, University of Montréal, Pavillon Marie-Victorin, Montréal, Québec, Canada
| | - Muriel Kielende
- School of Public Health, University of Montréal, Montréal, Québec, Canada
| | - Abdourahmane Coulibaly
- Faculty of Medicine and Odontostomatology, IRL 3189 Santé, Environnement, Société, Bamako, Mali
| | - Lara Gautier
- School of Public Health, University of Montréal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal, and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | | | - Nathan Peiffer-Smadja
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Inserm, IAME, Paris, France
| | - Ayako Honda
- Research Centre for Health Policy and Economics, Hitotsubashi Institute for Advanced Study (HIAS), Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo, Japan
| | | | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Kate Zinszer
- School of Public Health, Centre de recherche en santé publique, University of Montréal, Montréal, Québec, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal
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Honda A, de Araujo Oliveira SR, Ridde V, Zinszer K, Gautier L. Attributes and Organizational Factors that Enabled Innovation in Health Care Service Delivery during the COVID-19 Pandemic - Case Studies from Brazil, Canada and Japan. Health Syst Reform 2023; 9:2176022. [PMID: 37023218 DOI: 10.1080/23288604.2023.2176022] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Innovation by health service organizations can enable adaptation to and transformation of challenges caused by health shocks. Drawing on results from case studies in Brazil, Canada, and Japan, this study looked at innovations the study hospitals introduced in response to challenges caused by COVID-19 to identify: 1) attributes of the innovations that make them conducive to adoption; and 2) organizational factors that facilitate the creation and implementation of innovative health care approaches during health system shocks. Qualitative information was gathered using key informant interviews, participatory observations at the study hospitals and a review of relevant documentation. A thematic approach was used for analysis, and a cross-country comparison framework was prepared to synthesize findings from the case studies in the three countries. In response to the disruptions caused by COVID-19, the study hospitals undertook innovative changes in services, processes, organizational structures, and operational policy. The driving force behind the innovations was the need and urgency generated by the unprecedented nature of the pandemic. With COVID-19, if an innovation met the perceived needs of hospitals and provided an operational advantage, some level of complexity in the implementation appeared to be acceptable. The study findings suggest that for hospitals to create and implement innovations in response to health shocks, they need to: have adaptive and flexible organizational structures; build and maintain functioning communication systems; have committed leadership; ensure all staff share an understanding of hospital organizational and professional missions; and establish social networks that facilitate the creation and implementation of new ideas.
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Affiliation(s)
- Ayako Honda
- Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | | | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Kate Zinszer
- École de Santé Publique, Université de Montréal, Montreal, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Lara Gautier
- École de Santé Publique, Université de Montréal, Montreal, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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Coulibaly A, Chabrol F, Touré L, Hou R, Dramé BSI, Zinszer K, Ridde V. Responses to Hospital Restrictions on Family Visits during the COVID-19 Epidemic in Mali and France. Health Syst Reform 2023; 9:2241188. [PMID: 37676093 DOI: 10.1080/23288604.2023.2241188] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 07/15/2023] [Accepted: 07/22/2023] [Indexed: 09/08/2023] Open
Abstract
Few studies have focused on the presence of families in the hospital in the context of an epidemic. The present study aims to contribute to filling this gap by answering the following question: How did professionals, patients and their families cope with more or less drastic restrictions to family visits and presence during the COVID-19 pandemic in a French and a Malian hospital during the COVID-19 pandemic? Data were collected during the first two waves of the pandemic through 111 semi-structured interviews (France = 55, Mali = 56). Most of the interviews were conducted with staff (n = 103), but also with families in the case of Mali (n = 8). The investigators also conducted 150 days of field observations, 44 in France and 106 in Mali. Thematic analysis was applied using an inductive approach. Interviews were content analyzed to identify passages in the interviews that were relevant to these different themes. The study highlighted the difficulty for the medical-clinical system to provide appropriate responses to the many emotional needs of patients in a pandemic context. Families in France benefited from a support service to reduce stress, while in Mali, no initiative was taken in this sense. In both countries, families often used the telephone as an alternative means of communicating with relatives. The results showed that in the two contexts, the presence and involvement of the families contributed to a better response to the patients' psycho-affective demands and thus promoted resilience in this field.
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Affiliation(s)
- Abdourahmane Coulibaly
- Faculté de Médecine et d'Odontostomatologie, Bamako, Mali, IRL 3189 "Environnement, Santé, Sociétés," Agence de recherche MISELI, Bamako, Mali
| | - Fanny Chabrol
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
| | | | - Renyou Hou
- Laboratoire d'ethnologie et de sociologie comparative (LESC), Université Paris Nanterre, CNRS, Nanterre, France
| | | | - Kate Zinszer
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, F-75006, Paris, France
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Gagnon-Dufresne MC, Sarmiento I, Fortin G, Andersson N, Zinszer K. Why urban communities from low-income and middle-income countries participate in public and global health research: protocol for a scoping review. BMJ Open 2023; 13:e069340. [PMID: 37277224 DOI: 10.1136/bmjopen-2022-069340] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION As the number of people living in cities increases worldwide, particularly in low-income and middle-income countries (LMICs), urban health is a growing priority of public and global health. Rapid unplanned urbanisation in LMICs has exacerbated inequalities, putting the urban poor at increased risk of ill health due to difficult living conditions in cities. Collaboration with communities in research is a key strategy for addressing the challenges they face. The objective of this scoping review is, therefore, to identify factors that influence the participation of urban communities from LMICs in public and global health research. METHODS AND ANALYSIS We will develop a search strategy with a health librarian to explore the following databases: MEDLINE, Embase, Web of Science, Cochrane, Global Health and CINAHL. We will use MeSH terms and keywords exploring the concepts of 'low-income and middle-income countries', 'community participation in research' and 'urban settings' to look at empirical research conducted in English or French. There will be no restriction in terms of dates of publication. Two independent reviewers will screen and select studies, first based on titles and abstracts, and then on full text. Two reviewers will extract data. We will summarise the results using tables and fuzzy cognitive mapping. ETHICS AND DISSEMINATION This scoping review is part of a larger project to be approved by the University of Montréal's Research Ethics Committee for Science and Health in Montréal (Canada), and the Institutional Review Board of the James P Grant School of Public Health at BRAC University in Dhaka (Bangladesh). Results from the review will contribute to a participatory process seeking to combine scientific evidence with experiential knowledge of stakeholders in Dhaka to understand how to better collaborate with communities for research. The review could contribute to a shift toward research that is more inclusive and beneficial for communities.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Quebec, Canada
| | - Ivan Sarmiento
- Department of Family Medicine, McGill University, Montréal, Quebec, Canada
- Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogota, Colombia
| | - Geneviève Fortin
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Quebec, Canada
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montréal, Quebec, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autonoma de Guerrero - Campus Acapulco, Acapulco, Guerrero, Mexico
| | - Kate Zinszer
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Quebec, Canada
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Beaujoin C, Gautier L, Gagnon-Dufresne MC, Mikanagu R, Savard-Lamothe A, Cloos P, Ridde V, Zinszer K. "It felt like building a plane while in flight": the consideration of social inequalities in the design and planning of a contact-tracing intervention for COVID-19 in Montreal, Quebec. Can J Public Health 2023; 114:346-357. [PMID: 36940083 PMCID: PMC10026798 DOI: 10.17269/s41997-023-00759-4] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE In Canada and globally, the COVID-19 pandemic has increased social inequalities in health (SIH), furthering the vulnerability of certain groups and communities. Contact-tracing is a cornerstone intervention with COVID-19 prevention and control programs. The aim of this study was to describe whether and how SIH were considered during the design of the COVID-19 contact-tracing intervention in Montreal. METHODS This study is part of the multi-country research program HoSPiCOVID, looking at the resilience of public health systems during the COVID-19 pandemic. A descriptive qualitative study was carried out in Montreal, based on a "bricolage" conceptual framework describing the consideration for SIH in intervention and policy design. Qualitative data were collected using semi-structured interviews with 16 public health practitioners, recruited using both purposive and snowball sampling. Data were analyzed thematically, both inductively and deductively. RESULTS According to participants, SIH were not initially considered during the design of the contract-tracing intervention in Montreal. The participants were frustrated by the Minister of Health's initial resistance to integrating SIH into their public health response. However, adaptations were gradually made to better meet the needs of underserved populations. CONCLUSION There is a need for a clear and common vision of SIH within the public health system. Decision-makers need to consider SIH prior to designing public health interventions in order for these not to further increase SIH in the future, especially in the face of a health crisis.
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Affiliation(s)
- Camille Beaujoin
- School of Public Health, University of Montréal, Montréal, QC, Canada.
| | - Lara Gautier
- School of Public Health, University of Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), University of Montréal, Montréal, QC, Canada
| | - Marie-Catherine Gagnon-Dufresne
- School of Public Health, University of Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), University of Montréal, Montréal, QC, Canada
| | - Rachel Mikanagu
- School of Public Health, University of Montréal, Montréal, QC, Canada
| | | | - Patrick Cloos
- School of Public Health, University of Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), University of Montréal, Montréal, QC, Canada
- School of Social Work, University of Montréal, Montréal, QC, Canada
| | - Valéry Ridde
- Centre Population et Développement (CEPED), Institut de Recherche pour le Développement (IRD), Université de Paris, Paris, France
| | - Kate Zinszer
- School of Public Health, University of Montréal, Montréal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), University of Montréal, Montréal, QC, Canada
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Fortin G, Gagnon-Dufresne MC, Cooper S, Ferlatte O, Zinszer K. Global health and the urban poor: mobilising adolescents for sustainable cities and communities. BMJ Glob Health 2023; 8:bmjgh-2023-012624. [PMID: 37156561 PMCID: PMC10173957 DOI: 10.1136/bmjgh-2023-012624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023] Open
Affiliation(s)
- Geneviève Fortin
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montreal, Quebec, Canada
| | - Marie-Catherine Gagnon-Dufresne
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montreal, Quebec, Canada
| | - Sarah Cooper
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montreal, Quebec, Canada
| | - Olivier Ferlatte
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montreal, Quebec, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, University of Montreal School of Public Health, Montreal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Montreal, Quebec, Canada
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Gagnon-Dufresne MC, Azevedo Dantas M, Abreu Silva K, Souza dos Anjos J, Pessoa Carneiro Barbosa D, Porto Rosa R, de Luca W, Zahreddine M, Caprara A, Ridde V, Zinszer K. Social Media and the Influence of Fake News on Global Health Interventions: Implications for a Study on Dengue in Brazil. Int J Environ Res Public Health 2023; 20:5299. [PMID: 37047915 PMCID: PMC10093785 DOI: 10.3390/ijerph20075299] [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] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/13/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Social media usage is growing globally, with an exponential increase in low- and middle-income countries. Social media changes the ways in which information-sharing occurs, intensifying the population's exposure to misinformation, including fake news. This has important repercussions for global health. The spread of fake news can undermine the implementation of evidence-based interventions and weaken the credibility of scientific expertise. This is particularly worrisome in countries, such as Brazil, in a sociopolitical context characterized by a lack of popular trust in public institutions. In this project report, we describe our experience with the spread of fake news through the social media platform WhatsApp during the implementation of a cluster randomized controlled trial aimed at reducing dengue incidence in children in Fortaleza (Brazil). During initial visits to selected clusters, the research team was met with resistance. Then, soon after data collection started, fake news began circulating about the study. As a result, the research team developed strategies to dispel suspicion and further promote the study. However, the climate of violence and mistrust, coupled with the COVID-19 pandemic, forced the interruption of the study in 2019. The lessons learned from our experience in Fortaleza can be useful to other researchers and practitioners implementing large-scale interventions in this era of health-related misinformation.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, QC H3N 1X9, Canada
- Center for Public Health Research, Montreal, QC H3C 3J7, Canada
| | | | | | - Jean Souza dos Anjos
- Center for Humanities, Ceará State University, Fortaleza 60020-181, CE, Brazil
- Center for Applied Social Studies, Ceará State University, Fortaleza 60714-903, CE, Brazil
| | | | - Rebeca Porto Rosa
- Center for Health Sciences, Ceará State University, Fortaleza 60714-903, CE, Brazil
| | - William de Luca
- Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, QC H3N 1X9, Canada
| | | | - Andrea Caprara
- Center for Health Sciences, Ceará State University, Fortaleza 60714-903, CE, Brazil
| | - Valéry Ridde
- Population and Development Center, French National Research Institute for Sustainable Development, University of Paris, 75006 Paris, France
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health of the University of Montreal, Montreal, QC H3N 1X9, Canada
- Center for Public Health Research, Montreal, QC H3C 3J7, Canada
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Zinszer K, Charland K, Pierce L, Saucier A, McKinnon B, Hamelin MÈ, Cheriet I, Da Torre MB, Carbonneau J, Nguyen CT, De Serres G, Papenburg J, Boivin G, Quach C. Pre-Omicron seroprevalence, seroconversion, and seroreversion of infection-induced SARS-CoV-2 antibodies among a cohort of children and teenagers in Montreal, Canada. Int J Infect Dis 2023; 131:119-126. [PMID: 36963656 PMCID: PMC10033142 DOI: 10.1016/j.ijid.2023.03.036] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/22/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE To use serological testing to assess the pre-Omicron seroprevalence, seroconversion, and seroreversion of infection-induced SARS-CoV-2 antibodies in children and adolescents in Montreal, Canada. DESIGN This analysis is from a prospective cohort study of children aged 2 to 17 years (at baseline) that included blood spots (DBS) for antibody detection. The serostatus of participants was determined by enzyme-linked immunosorbent assays (ELISAs) using the receptor-binding domain (RBD) from the spike protein and the nucleocapsid protein (N) as antigens. We estimated seroprevalence, seroconversion rates, and the likelihood of seroreversion at six months and one year. RESULTS The baseline (October 2020 to April 2021) seroprevalence was 5.8% (95% CI 4.8-7.1), which increased to 10.5% (May to September 2021) and 11.0% (November 2021 to March 2022) for the respective follow-ups (95% CI 8.6-12.7; 95% CI 8.8-13.5). The crude rate of seroconversion over the study period was 12.8 per 100 person-years (95% CI 11.0-14.7). Adjusted hazard rates of seroconversion by child characteristics showed higher rates in children who were female, whose parent identified as a racial or ethnic minority, and in households with incomes in the lowest tercile of our study population. The likelihood of remaining seropositive at six months was 68% (95% CI 60%-77%) and dropped to 42% (95% CI 32%-56%) at one year. CONCLUSIONS Serological studies continue to provide valuable contributions for infection prevalence estimates and help us better understand the dynamics of antibody levels following infection.
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Affiliation(s)
- Kate Zinszer
- University of Montreal, Montreal, Quebec, Canada; Centre for Public Health Research, Montreal, Quebec, Canada.
| | - Katia Charland
- Centre for Public Health Research, Montreal, Quebec, Canada
| | - Laura Pierce
- Centre for Public Health Research, Montreal, Quebec, Canada
| | - Adrien Saucier
- University of Montreal, Montreal, Quebec, Canada; Centre for Public Health Research, Montreal, Quebec, Canada
| | - Britt McKinnon
- Centre for Public Health Research, Montreal, Quebec, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marie-Ève Hamelin
- Infectious Disease Research Center, Research Centre of Quebec-Université Laval, Quebec City, Quebec, Canada
| | | | - Margot Barbosa Da Torre
- University of Montreal, Montreal, Quebec, Canada; Centre for Public Health Research, Montreal, Quebec, Canada
| | - Julie Carbonneau
- Infectious Disease Research Center, Research Centre of Quebec-Université Laval, Quebec City, Quebec, Canada
| | - Cat Tuong Nguyen
- Ministère de la santé et des services sociaux, Quebec City, Quebec, Canada
| | - Gaston De Serres
- National Institute of Public Health of Quebec, Quebec City, Quebec, Canada
| | - Jesse Papenburg
- Montreal Children's Hospital of the McGill University Health Centre
| | - Guy Boivin
- Infectious Disease Research Center, Research Centre of Quebec-Université Laval, Quebec City, Quebec, Canada
| | - Caroline Quach
- University of Montreal, Montreal, Quebec, Canada; Research Centre of the Sainte-Justine University Hospital, Montreal, Quebec, Canada
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Boivin P, Gautier L, Coulibaly A, Zinszer K, Ridde V. Exploring how social inequalities in health have influenced the design of Mali's SARS-CoV-2 testing policy: a qualitative study. Health Policy Plan 2023; 38:301-309. [PMID: 36398987 DOI: 10.1093/heapol/czac097] [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] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
Abstract
In the fight against infectious diseases, social inequalities in health (SIH) are generally forgotten. Mali, already weakened by security and political unrest, has not been spared by the COVID-19 pandemic. Although the country was unprepared, the authorities were quick to implement public health measures, including a SARS-CoV-2 testing programme. This study aimed to understand if and how social inequalities in health were addressed in the design and planning for the national COVID-19 testing policy in Mali. A qualitative survey was conducted between March and April 2021 in Bamako, the capital of Mali. A total of 26 interviews were conducted with key government actors and national and international partners. A document review of national reports and policy documents complemented this data collection. The results demonstrated that the concept of SIH was unclear to the participants and was not a priority. The authorities focused on a symptom-based testing strategy that was publicly available. Participants also mentioned some efforts to reduce inequalities across geographical territories. The reflection and consideration of SIH within COVID-19 interventions was difficult given the governance approach to response efforts. The urgency of the situation, the perceptions of COVID-19 and the country's pre-existing fragility were factors limiting this reflection. Over time, little action has been taken to adapt to the specific needs of certain groups in the Malian population. This study (re)highlights the need to consider SIH in the planning stages of a public health intervention, to adapt its implementation and to limit the negative impact on SIH.
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Affiliation(s)
- Pauline Boivin
- Miseli, Unité de recherche en sciences sociales, Ilot n°17, Cité El Farako, Bamako, BP E 5448, Mali
| | - Lara Gautier
- School of Public Health, University of Montreal, 7101 Park Avenue, Montreal, Quebec H3N 1X9, Canada
- Centre de recherche en santé publique (CReSP), University of Montreal, 7101 Park Avenue, Montreal, Quebec H3N 1X9, Canada
| | - Abdourahmane Coulibaly
- Miseli, Unité de recherche en sciences sociales, Ilot n°17, Cité El Farako, Bamako, BP E 5448, Mali
| | - Kate Zinszer
- School of Public Health, University of Montreal, 7101 Park Avenue, Montreal, Quebec H3N 1X9, Canada
- Centre de recherche en santé publique (CReSP), University of Montreal, 7101 Park Avenue, Montreal, Quebec H3N 1X9, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, 45 rue des Saints-Pères, Paris F-75006, France
- Institut de Santé et Développement, Université Cheikh Anta Diop, Dakar, Senegal
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31
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Zinszer K, Talisuna AO. Fighting insecticide resistance in malaria control. Lancet Infect Dis 2023; 23:138-139. [PMID: 36174593 DOI: 10.1016/s1473-3099(22)00518-7] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Kate Zinszer
- School of Public Health, University of Montreal, Montreal, QC H3N 1X9, Canada; Centre for Public Health Research, Montreal, QC, Canada.
| | - Ambrose Otau Talisuna
- Emergency Preparedness and Response Cluster, WHO, Regional Office for Africa, Brazzaville, Congo
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Richard Z, Chabrol F, Gautier L, Zinszer K, Ridde V. Considering social inequalities in health in COVID-19 response: insights from a French case study. Health Promot Int 2023; 38:6974796. [PMID: 36617297 DOI: 10.1093/heapro/daac173] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 01/09/2023] Open
Abstract
The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.
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Affiliation(s)
- Zoé Richard
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France
| | - Fanny Chabrol
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France
| | - Lara Gautier
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'île-de-Montréal, Montréal, Québec, Canada
| | - Kate Zinszer
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'île-de-Montréal, Montréal, Québec, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France
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Slatculescu AM, Pugliese M, Sander B, Zinszer K, Nelder MP, Russell CB, Kulkarni MA. Rurality, Socioeconomic Status, and Residence in Environmental Risk Areas Associated with Increased Lyme Disease Incidence in Ontario, Canada: A Case-Control Study. Vector Borne Zoonotic Dis 2022; 22:572-581. [PMID: 36378243 DOI: 10.1089/vbz.2022.0044] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Lyme disease (LD) is the most common tick-borne illness in North America. LD is acquired through exposure to the tick vector, Ixodes scapularis, known as the blacklegged tick. In Canada, LD is rapidly emerging, with the establishment of I. scapularis in many newly endemic regions posing a growing risk to local communities. In the Canadian context, many environmental and socioeconomic risk factors for human LD infection are yet to be ascertained and the degree of risk associated with residential and community exposure to ticks is not well known. Methods: We conducted a matched case-control study in southeastern Ontario, using LD patient data from provincial laboratory databases and uninfected population controls from 2014 to 2018. We aimed to identify area-level risk factors for LD and associations with residence in environmental risk areas, defined as areas with high model-predicted probability of I. scapularis occurrence, using the neighborhood dissemination area as the unit of analysis. Results: Using multivariable conditional logistic regression analysis, we identified that patients with LD had higher odds (odds ratio, OR; 95% confidence interval, CI) of living in neighborhoods with high probability of tick occurrence in the environment (OR = 2.2; 95% CI: 2.0-2.5), low walkability (OR = 1.6; 95% CI: 1.2-2.1), low material deprivation (OR = 1.4; 95% CI: 1.2-1.7), and low ethnic concentration (OR = 8.1; 95% CI: 6.7-9.9). We also found that the odds of LD infection for individuals residing in environmental risk areas was highest for those living in public health units (PHUs) with <250,000 population (OR = 3.0; 95% CI: 2.4-3.9) compared to those living in PHUs with >1,000,000 population (OR = 1.5; 95% CI: 1.1-2.1). Conclusion: This study shows that odds of human LD infection in Ontario, Canada is higher in less urbanized areas with higher socioeconomic status and indicates that exposure to ticks around the home residence or neighborhood is linked to increased odds of LD.
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Affiliation(s)
- Andreea M Slatculescu
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Michael Pugliese
- ICES uOttawa, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada.,ICES Central, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Kate Zinszer
- École de Santé Publique, Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Canada
| | | | | | - Manisha A Kulkarni
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Gagnon-Dufresne MC, Fortin G, Bunkeddeko K, Kalumuna C, Zinszer K. Understanding malnutrition management through a socioecological lens: Evaluation of a community-based child malnutrition program in rural Uganda. Health Soc Care Community 2022; 30:e5998-e6008. [PMID: 36148516 DOI: 10.1111/hsc.14032] [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: 03/14/2022] [Revised: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
In Uganda, almost half of children under 5 years old suffer from undernutrition. Undernutrition, a common form of malnutrition in children, encompasses stunting, wasting and underweight. The causes of child undernutrition are complex, suggesting that interventions to tackle malnutrition must be multifaceted. Furthermore, limited access to healthcare for vulnerable populations restricts the potential of hospital-based strategies. Community-based management of acute malnutrition (CMAM), which includes nutritional counselling, ready-to-use therapeutic foods and the outpatient management of malnutrition by caregivers, is recognised as an effective approach for children's recovery. However, evaluations of CMAM programs are largely based on biomedical and behavioural health models, failing to incorporate structural factors that influence malnutrition management. The objective of this evaluation was to understand the factors influencing malnutrition management in a CMAM program in rural Uganda, using the socioecological model to assess the multilevel determinants of outpatient malnutrition management. This evaluation used qualitative methods to identify factors related to caregivers, healthcare providers and societal structures that influence children's outpatient care. Data were collected at a community health clinic in 2019 through observations and interviews with caregivers of malnourished children. We observed 14 caregiver-provider encounters and interviewed 15 caregivers to examine factors hindering outpatient malnutrition management. Data were thematically analysed informed by the socioecological model. Findings showed that caregivers had a limited understanding of malnutrition. Counselling offered to caregivers was inconsistent and insufficient. Poverty and gender inequality limited caregivers' access to healthcare and their ability to care for their children. Factors at the caregiver and healthcare levels interacted with societal factors to shape malnutrition management. Results suggest that CMAM programs would benefit from providing holistic interventions to tackle the structural barriers to children's care. Using a socioecological approach to program evaluation could help move beyond individual determinants to address the social dynamics shaping malnutrition management in low- and middle-income countries.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- School of Public Health, University of Montréal, Montréal, Quebec, Canada
- Centre for Public Health Research, Montréal, Quebec, Canada
| | - Geneviève Fortin
- School of Public Health, University of Montréal, Montréal, Quebec, Canada
- Centre for Public Health Research, Montréal, Quebec, Canada
| | | | | | - Kate Zinszer
- School of Public Health, University of Montréal, Montréal, Quebec, Canada
- Centre for Public Health Research, Montréal, Quebec, Canada
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Blanchard AC, Desforges M, Labbé AC, Nguyen CT, Petit Y, Besner D, Zinszer K, Séguin O, Laghdir Z, Adams K, Benoit MÈ, Leduc G, Longtin J, Ragoussis J, Buckeridge DL, Quach C. Evaluation of Real-life Use of Point-of-care Rapid Antigen Testing for SARS-CoV-2 in Schools (EPOCRATES): a cohort study. CMAJ Open 2022; 10:E1027-E1033. [PMID: 36622324 PMCID: PMC9744263 DOI: 10.9778/cmajo.20210327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND SARS-CoV-2 transmission has an impact on education. In this study, we assessed the performance of rapid antigen detection tests (RADTs) versus polymerase chain reaction (PCR) for the diagnosis of SARS-CoV-2 infection in school settings, and RADT use for monitoring exposed contacts. METHODS In this real-world, prospective observational cohort study, high-school students and staff were recruited from 2 high schools in Montréal, Canada, and followed from Jan. 25 to June 10, 2021. Twenty-five percent of asymptomatic participants were tested weekly by RADT (nasal) and PCR (gargle). Class contacts of cases were tested. Symptomatic participants were tested by RADT (nasal) and PCR (nasal and gargle). The number of cases and outbreaks were compared with those of other high schools in the same area. RESULTS Overall, 2099 students and 286 school staff members consented to participate. The overall specificity of RADTs varied from 99.8% to 100%, with a lower sensitivity, varying from 28.6% in asymptomatic to 83.3% in symptomatic participants. Secondary cases were identified in 10 of 35 classes. Returning students to school after a 7-day quarantine, with a negative PCR result on days 6-7 after exposure, did not lead to subsequent outbreaks. Of cases for whom the source was known, 37 of 51 (72.5%) were secondary to household transmission, 13 (25.5%) to intraschool transmission, and 1 to community contacts between students in the same school. INTERPRETATION Rapid antigen detection tests did not perform well compared with PCR in asymptomatic individuals. Reinforcing policies for symptom screening when entering schools and testing symptomatic individuals with RADTs on the spot may avoid subsequent substantial exposures in class. Preprint: medRxiv - doi.org/10.1101/2021.10.13.21264960.
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Affiliation(s)
- Ana C Blanchard
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Marc Desforges
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Annie-Claude Labbé
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Cat Tuong Nguyen
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Yves Petit
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Dominic Besner
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Kate Zinszer
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Olivier Séguin
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Zineb Laghdir
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Kelsey Adams
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Marie-Ève Benoit
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Geneviève Leduc
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Jean Longtin
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Jiannis Ragoussis
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - David L Buckeridge
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que
| | - Caroline Quach
- Division of Infectious Diseases (Blanchard), Department of Paediatrics, CHU Sainte-Justine, Université de Montréal; Clinical Department of Laboratory Medicine (Desforges, Quach), CHU Sainte-Justine; Department of Microbiology, Infectious Diseases and Immunology (Desforges, Labbé, Quach), Université de Montréal; Division of Infectious Diseases (Labbé), Department of Medicine, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l'Est-de-l'Île-de-Montréal; Direction régionale de santé publique (Nguyen, Séguin), CIUSSS du Centre-Sud-de-l'île-de-Montréal; Pensionnat du Saint-Nom-de-Marie (Petit); École secondaire Calixa-Lavallée (Besner); École de santé publique de l'Université de Montréal (Zinszer), Université de Montréal; CHU Sainte-Justine Research Center (Laghdir, Adams, Benoit, Leduc), Montréal, Que.; Clinical Department of Laboratory Medicine (Longtin), CHU de Québec, Québec, Que.; McGill Genome Centre (Ragoussis), and Department of Epidemiology, Biostatistics and Occupational Health (Buckeridge), McGill University, Montréal, Que.
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Savard Lamothe A, Gabet M, Richard Z, Oliveira SRDA, Coulibaly A, Cazarin G, Zacarias A, Gautier L, Ridde V, Zinszer K. A Descriptive Comparison of Mass Testing During the COVID-19 Pandemic in Montreal, Paris, Bamako, and Recife. Int J Public Health 2022; 67:1604992. [PMID: 36213140 PMCID: PMC9537363 DOI: 10.3389/ijph.2022.1604992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: The aim of this descriptive article was to compare mass testing for SARS-CoV-2 during the first wave of the COVID-19 pandemic in Montreal, Canada; Bamako, Mali; Paris, France; and Recife, Brazil.Methods: Data was collected through interviews with key informants involved in the testing response and a review of the grey literature. The TIDieR-PHP checklist was then used to provide the basis of the intervention descriptions and to compare the data between cities.Results: Descriptive comparisons revealed that the type of test, the testing process, and materials used were similar between the cities during the first wave of the pandemic. In addition, all cities experienced similar material and personnel resource shortages, directly affecting testing accessibility and capacity. The main differences were related to testing capacity and implementation timelines, which were dependent on the state of the health care systems, governance, and access to resources.Conclusion: Results of this study highlight the similarities and differences in testing between the cities and demonstrate the importance of comprehensive intervention descriptions to highlight lessons learned, increase knowledge sharing, and inform policy decisions.
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Affiliation(s)
- Ashley Savard Lamothe
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- *Correspondence: Ashley Savard Lamothe,
| | - Morgane Gabet
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Zoé Richard
- Institut de Recherche pour le Développement (IRD) Université de Paris, Paris, France
- Centre Population et Développement (Ceped), Paris, France
| | | | | | - Gisèle Cazarin
- Institut Aggeu Magalhães, Oswaldo Cruz Fondacion, Recife, Brazil
| | - Amanda Zacarias
- Institut Aggeu Magalhães, Oswaldo Cruz Fondacion, Recife, Brazil
| | - Lara Gautier
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada
| | - Valéry Ridde
- Institut de Recherche pour le Développement (IRD) Université de Paris, Paris, France
- Centre Population et Développement (Ceped), Paris, France
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, QC, Canada
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Freitas LP, Carabali M, Yuan M, Jaramillo-Ramirez GI, Balaguera CG, Restrepo BN, Zinszer K. Spatio-temporal clusters and patterns of spread of dengue, chikungunya, and Zika in Colombia. PLoS Negl Trop Dis 2022; 16:e0010334. [PMID: 35998165 PMCID: PMC9439233 DOI: 10.1371/journal.pntd.0010334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/02/2022] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background Colombia has one of the highest burdens of arboviruses in South America. The country was in a state of hyperendemicity between 2014 and 2016, with co-circulation of several Aedes-borne viruses, including a syndemic of dengue, chikungunya, and Zika in 2015. Methodology/Principal findings We analyzed the cases of dengue, chikungunya, and Zika notified in Colombia from January 2014 to December 2018 by municipality and week. The trajectory and velocity of spread was studied using trend surface analysis, and spatio-temporal high-risk clusters for each disease in separate and for the three diseases simultaneously (multivariate) were identified using Kulldorff’s scan statistics. During the study period, there were 366,628, 77,345 and 74,793 cases of dengue, chikungunya, and Zika, respectively, in Colombia. The spread patterns for chikungunya and Zika were similar, although Zika’s spread was accelerated. Both chikungunya and Zika mainly spread from the regions on the Atlantic coast and the south-west to the rest of the country. We identified 21, 16, and 13 spatio-temporal clusters of dengue, chikungunya and Zika, respectively, and, from the multivariate analysis, 20 spatio-temporal clusters, among which 7 were simultaneous for the three diseases. For all disease-specific analyses and the multivariate analysis, the most-likely cluster was identified in the south-western region of Colombia, including the Valle del Cauca department. Conclusions/Significance The results further our understanding of emerging Aedes-borne diseases in Colombia by providing useful evidence on their potential site of entry and spread trajectory within the country, and identifying spatio-temporal disease-specific and multivariate high-risk clusters of dengue, chikungunya, and Zika, information that can be used to target interventions. Dengue, chikungunya, and Zika are diseases transmitted to humans by the bite of infected Aedes mosquitoes. Between 2014 and 2016 chikungunya and Zika viruses started causing outbreaks in Colombia, one of the countries historically most affected by dengue. We used case counts of the diseases by municipality and week to study the spread trajectory of chikungunya and Zika within Colombia’s territory, and to identify space-time high-risk clusters, i.e., the areas and time periods that dengue, chikungunya, and Zika were more present. Chikungunya and Zika spread similarly in Colombia, but Zika spread faster. The Atlantic coast, a famous touristic destination in the country, was likely the place of entry of chikungunya and Zika in Colombia. The south-western region was identified as a high-risk cluster for all three diseases in separate and simultaneously. This region has a favorable climate for the Aedes mosquitoes and other characteristics that facilitate the diseases’ transmission, such as social deprivation and high population mobility. Our results provide useful information on the locations that should be prioritized for interventions to prevent the entry of new diseases transmitted by Aedes and to reduce the burden of dengue, chikungunya and Zika where they are established.
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Affiliation(s)
- Laís Picinini Freitas
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montreal, Quebec, Canada
| | - Mabel Carabali
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montreal, Quebec, Canada
| | - Mengru Yuan
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Berta N. Restrepo
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Kate Zinszer
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montreal, Quebec, Canada
- * E-mail:
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Zhang XS, Charland K, Quach C, Nguyen QD, Zinszer K. Institutional, therapeutic, and individual factors associated with 30-day mortality after COVID-19 diagnosis in Canadian long-term care facilities. J Am Geriatr Soc 2022; 70:3210-3220. [PMID: 35906882 PMCID: PMC9353371 DOI: 10.1111/jgs.17975] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 05/23/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
Background Canadian long‐term care facility (LTCF) residents experienced higher death rates compared to other countries during the first wave of the COVID‐19 pandemic. This cohort study analyzes the individual, therapeutic, and institutional factors associated with death in LTCFs. Methods Institutional data for 17 LTCFs in Montreal, Canada were obtained from local administrative registries. Individual data for 1197 residents infected by SARS‐CoV‐2 between February 23 and July 11, 2020 were obtained through chart reviews. A multivariable modified Poisson regression model, which accounted for LTCF clustering, was used to identify resident and facility covariates associated with 30‐day mortality after COVID‐19 diagnosis. Results Severe shortage of licensed practical nurses (RR 2.60 95% CI 1.20–5.61) and medium‐sized facilities compared to smaller‐sized facilities (RR 2.73 95% CI 1.23–6.07) were associated with 30‐day mortality. Later COVID‐19 diagnosis (RR 0.98 95% CI 0.97–0.99 per additional day) was associated with survival. Individual risk factors for death included age (RR 1.33 95% CI 1.23–1.45 per additional 10 years), male sex (RR 1.46 95% CI 1.24–1.71), functional impairment (RR 1.08 95% CI 1.04–1.12 per unit increase of SMAF), as well as a diagnosis of congestive heart failure (RR 1.31 95% CI 1.04–1.66) and neurocognitive disorder (RR 1.31 95% CI 1.01–1.70). Among severe cases, anticoagulation was associated with survival (RR 0.70 95% CI 0.51–0.96). Conclusions This study identified practical nurse shortages and facility size as institutional risk factors for COVID‐19 death. Anticoagulation was associated with survival among severe cases.
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Affiliation(s)
- Xi Sophie Zhang
- Department of General Medicine, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.,Department of Family and Emergency Medicine, University of Montreal, Montreal, Canada
| | | | - Caroline Quach
- Department of Microbiology, Infectious Disease, and Immunology, University of Montreal, Montreal, Canada.,Clinical Department of Laboratory Medicine, Centre hospitalier universitaire de Sainte-Justine (CHUSJ), Montreal, Canada
| | - Quoc Dinh Nguyen
- Department of Geriatric Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada.,Department of Medicine, University of Montreal, Montreal, Canada
| | - Kate Zinszer
- Centre de recherche en santé publique, Montreal, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
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Sadoine ML, Smargiassi A, Liu Y, Gachon P, Dueymes G, Dorsey G, Fournier M, Nankabirwa JI, Rek J, Zinszer K. The influence of the environment and indoor residual spraying on malaria risk in a cohort of children in Uganda. Sci Rep 2022; 12:11537. [PMID: 35798826 PMCID: PMC9262898 DOI: 10.1038/s41598-022-15654-0] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/27/2022] [Indexed: 12/24/2022] Open
Abstract
Studies have estimated the impact of the environment on malaria incidence although few have explored the differential impact due to malaria control interventions. Therefore, the objective of the study was to evaluate the effect of indoor residual spraying (IRS) on the relationship between malaria and environment (i.e. rainfall, temperatures, humidity, and vegetation) using data from a dynamic cohort of children from three sub-counties in Uganda. Environmental variables were extracted from remote sensing sources and averaged over different time periods. General linear mixed models were constructed for each sub-counties based on a log-binomial distribution. The influence of IRS was analysed by comparing marginal effects of environment in models adjusted and unadjusted for IRS. Great regional variability in the shape (linear and non-linear), direction, and magnitude of environmental associations with malaria risk were observed between sub-counties. IRS was significantly associated with malaria risk reduction (risk ratios vary from RR = 0.03, CI 95% [0.03-0.08] to RR = 0.35, CI95% [0.28-0.42]). Model adjustment for this intervention changed the magnitude and/or direction of environment-malaria associations, suggesting an interaction effect. This study evaluated the potential influence of IRS in the malaria-environment association and highlighted the necessity to control for interventions when they are performed to properly estimate the environmental influence on malaria. Local models are more informative to guide intervention program compared to national models.
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Affiliation(s)
- Margaux L. Sadoine
- grid.14848.310000 0001 2292 3357School of Public Health, Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Public Health Research Center, Université de Montréal, Montréal, Québec Canada
| | - Audrey Smargiassi
- grid.14848.310000 0001 2292 3357School of Public Health, Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Public Health Research Center, Université de Montréal, Montréal, Québec Canada
| | - Ying Liu
- grid.14848.310000 0001 2292 3357School of Public Health, Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Public Health Research Center, Université de Montréal, Montréal, Québec Canada
| | - Philippe Gachon
- grid.38678.320000 0001 2181 0211ESCER (Étude et Simulation du Climat à l’Échelle Régionale) Centre, Université du Québec à Montréal, Montréal, Québec Canada
| | - Guillaume Dueymes
- grid.38678.320000 0001 2181 0211ESCER (Étude et Simulation du Climat à l’Échelle Régionale) Centre, Université du Québec à Montréal, Montréal, Québec Canada
| | - Grant Dorsey
- grid.266102.10000 0001 2297 6811University of California San Francisco, San Francisco, USA
| | - Michel Fournier
- Montreal Regional Department of Public Health, Montréal, Québec Canada
| | - Joaniter I. Nankabirwa
- grid.463352.50000 0004 8340 3103Infectious Disease Research Collaboration, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - John Rek
- grid.463352.50000 0004 8340 3103Infectious Disease Research Collaboration, Kampala, Uganda
| | - Kate Zinszer
- grid.14848.310000 0001 2292 3357School of Public Health, Université de Montréal, Montréal, Québec Canada ,grid.14848.310000 0001 2292 3357Public Health Research Center, Université de Montréal, Montréal, Québec Canada
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Mac-Seing M, Ochola E, Ogwang M, Zinszer K, Zarowsky C. Policy Implementation Challenges and Barriers to Access Sexual and Reproductive Health Services Faced By People With Disabilities: An Intersectional Analysis of Policy Actors' Perspectives in Post-Conflict Northern Uganda. Int J Health Policy Manag 2022; 11:1187-1196. [PMID: 33906334 PMCID: PMC9808201 DOI: 10.34172/ijhpm.2021.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/28/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Emerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors' perceptions of existing pro-disability legislation and policy implementation, their perceptions of potential barriers experienced by people with disabilities in accessing and using SRH services in post-conflict Northern Uganda, and their recommendations on how to redress these inequities. METHODS Through an intersectionality-informed approach, we conducted and thematically analysed 13 in-depth semi-structured interviews with macro level policy actors (national policy-makers and international and national organisations); seven focus groups (FGs) at meso level with 68 health service providers and representatives of disabled people's organisations (DPOs); and a two-day participatory workshop on disability-sensitive health service provision for 34 healthcare providers. RESULTS We identified four main themes: (1) legislation and policy implementation was fraught with numerous technical and financial challenges, coupled with lack of prioritisation of disability issues; (2) people with disabilities experienced multiple physical, attitudinal, communication, and structural barriers to access and use SRH services; (3) the conflict was perceived to have persisting impacts on the access to services; and (4) policy actors recommended concrete solutions to reduce health inequities faced by people with disabilities. CONCLUSION This study provides substantial evidence of the multilayered disadvantages people with disabilities face when using SRH services and the difficulty of implementing disability-focused policy in Uganda. Informed by an intersectionality approach, policy actors were able to identify concrete solutions and recommendations beyond the identification of problems. These recommendations can be acted upon in a practical road map to remove different types of barriers in the access to SRH services by people with disabilities, irrespective of their geographic location in Uganda.
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Affiliation(s)
- Muriel Mac-Seing
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada
| | | | - Martin Ogwang
- Institutional Direction Department, St-Mary’s Hospital, Lacor, Uganda
| | - Kate Zinszer
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada
| | - Christina Zarowsky
- Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada
- School of Public Health, University of Western Cape, Bellville, South Africa
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Gagnon-Dufresne MC, Gautier L, Beaujoin C, Lamothe AS, Mikanagu R, Cloos P, Ridde V, Zinszer K. Considering social inequalities in health in large-scale testing for COVID-19 in Montréal: a qualitative case study. BMC Public Health 2022; 22:749. [PMID: 35422030 PMCID: PMC9008388 DOI: 10.1186/s12889-022-13163-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/05/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Evidence continues to demonstrate that certain marginalised populations are disproportionately affected by COVID-19. While many studies document the impacts of COVID-19 on social inequalities in health, none has examined how public health responses to the pandemic have unfolded to address these inequities in Canada. The purpose of our study was to assess how social inequalities in health were considered in the design and planning of large-scale COVID-19 testing programs in Montréal (Québec, Canada). METHODS Part of the multicountry study HoSPiCOVID, this article reports on a qualitative case study of large-scale testing for COVID-19 in Montréal. We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using existing literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo. RESULTS Our findings suggest that large-scale COVID-19 testing in Montréal did not initially consider social inequalities in health in its design and planning phases. Considering the sense of urgency brought by the pandemic, participants noted the challenges linked to the uptake of an intersectoral approach and of a unified vision of social inequalities in health. However, adaptations were gradually made to large-scale testing to improve its accessibility, acceptability, and availability. Actors from the community sector, among others, played an important role in supporting the health sector to address the needs of specific subgroups of the population. CONCLUSIONS These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programs must tackle structural barriers to accessing healthcare services during health crises. This will be necessary to ensure that pandemic preparedness and response, including large-scale testing, do not further increase social inequalities in health.
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Affiliation(s)
- Marie-Catherine Gagnon-Dufresne
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada.
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada.
| | - Lara Gautier
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
- Department of health management, evaluation and policy, School of Public Health, University of Montréal, Montréal, Québec, Canada
| | - Camille Beaujoin
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
| | - Ashley Savard Lamothe
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
| | - Rachel Mikanagu
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
| | - Patrick Cloos
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
- School of Social Work, University of Montréal, Montréal, Canada
| | - Valéry Ridde
- Centre Population et Développement, Institut de recherche pour le développement (IRD), Université de Paris, Paris, France
| | - Kate Zinszer
- Department of social and preventive medicine, School of Public Health, University of Montréal, 7101 Park Avenue, Montréal, Québec, H3N 1X9, Canada
- Centre de recherche en santé publique (CReSP), Montréal, Québec, Canada
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Stennett J, Hou R, Traverson L, Ridde V, Zinszer K, Chabrol F. Lessons Learned From the Resilience of Chinese Hospitals to the COVID-19 Pandemic: Scoping Review. JMIRx Med 2022; 3:e31272. [PMID: 35435649 PMCID: PMC9004618 DOI: 10.2196/31272] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/05/2021] [Accepted: 12/06/2021] [Indexed: 01/17/2023]
Abstract
Background The SARS-CoV-2 pandemic has brought substantial strain on hospitals worldwide; however, although the success of China’s COVID-19 strategy has been attributed to the achievements of the government, public health officials, and the attitudes of the public, the resilience shown by China’s hospitals appears to have been a critical factor in their successful response to the pandemic. Objective This paper aims to determine the key findings, recommendations, and lessons learned in terms of hospital resilience during the pandemic; analyze the quality and limitations of research in this field at present; and contribute to the evaluation of the Chinese response to the COVID-19 outbreak, building on a growing literature on the role of hospital resilience in crisis situations. Methods We conducted a scoping review of evidence on the resilience of hospitals in China during the COVID-19 crisis in the first half of 2020. Two online databases (the China National Knowledge Infrastructure and World Health Organization databases) were used to identify papers meeting the eligibility criteria. After extracting the data, we present an information synthesis using a resilience framework. Articles were included in the review if they were peer-reviewed studies published between December 2019 and July 2020 in English or Chinese and included empirical results pertaining to the resilience of Chinese hospitals in the COVID-19 pandemic. Results From the publications meeting the criteria (n=59), we found that substantial research was rapidly produced in the first half of 2020 and described numerous strategies used to improve hospital resilience, particularly in three key areas: human resources; management and communication; and security, hygiene, and planning. Our search revealed a focus on interventions related to training, health care worker well-being, eHealth/telemedicine, and workplace organization, while other areas such as hospital financing, information systems, and health care infrastructure were less well represented in the literature. We also noted that the literature was dominated by descriptive case studies, often lacking consideration of methodological limitations, and that there was a lack of both highly focused research on specific interventions and holistic research that attempted to unite the topics within a resilience framework. Conclusions We identified a number of lessons learned regarding how China’s hospitals have demonstrated resilience when confronted with the SARS-CoV-2 pandemic. Strategies involving interprovincial reinforcements, online platforms and technological interventions, and meticulous personal protective equipment use and disinfection, combined with the creation of new interdisciplinary teams and management strategies, reflect a proactive hospital response to the pandemic, with high levels of redundancy. Research on Chinese hospitals would benefit from a greater range of analyses to draw more nuanced and contextualized lessons from the responses to the crisis.
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Affiliation(s)
- Jack Stennett
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
| | - Renyou Hou
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
| | - Lola Traverson
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
| | - Valéry Ridde
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
| | - Kate Zinszer
- Centre de Recherche en Santé Publique Université de Montréal Montréal, QC Canada
| | - Fanny Chabrol
- Centre Population et Développement Institut de Recherche pour le Développement Université de Paris Paris France
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McKinnon B, Abalovi K, Vandermorris A, Dubé È, Tuong Nguyen C, Billou N, Fortin G, Parvez M, Senga J, Abou-Malhab J, Antoine Bellamy M, Quach C, Zinszer K. Using human-centred design to tackle COVID-19 vaccine hesitancy for children and youth: a protocol for a mixed-methods study in Montreal, Canada. BMJ Open 2022; 12:e061908. [PMID: 35383090 PMCID: PMC8983461 DOI: 10.1136/bmjopen-2022-061908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION To successfully combat COVID-19 vaccine hesitancy and increase uptake, research has demonstrated that interventions are most effective when tailored to meet local needs through active engagement and co-development with communities. This mixed-methods project uses a human-centred design (HCD) approach to understand local perspectives of COVID-19 vaccine hesitancy and develop strategies to enhance vaccine confidence for children and adolescents. METHODS AND ANALYSIS Project ECHO (Étude Communautaire sur l'Hésitation vaccinale contre la COVID-19) combines population-based surveys of parents and adolescents with community-based participatory action research to design and pilot strategies to enhance COVID-19 vaccine confidence in two underserved and ethnoculturally diverse neighbourhoods of Montreal, Canada. Two surveys conducted 6 months apart through primary and secondary schools are used to monitor vaccine acceptance and its social determinants among children and youth. Analyses of survey data include descriptive and inferential statistical approaches. Community-led design teams of parents and youth from the two participating neighbourhoods, supported by academic researchers, design thinking experts and community partners, use an HCD approach to: (1) gather data to understand COVID-19 vaccine decision-making among parents and youth in their community and frame a design challenge (inspiration phase); (2) develop an intervention to address the design challenge (ideation phase) and (3) pilot the intervention (implementation phase). Strategies to evaluate the community-led interventions will be co-developed during the implementation phase. ETHICS AND DISSEMINATION This study has been approved by the research ethics boards of the Sainte-Justine University Hospital Centre and the University of Montreal. Community design teams will be involved in the dissemination of findings and the design of knowledge translation initiatives that foster dialogue related to COVID-19 vaccination for children and adolescents among community, school and public health stakeholders. Findings will be disseminated through peer-reviewed publications, conference presentations, community forums, policy briefs, and social media content.
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Affiliation(s)
- Britt McKinnon
- Centre de recherche en santé publique, Université de Montréal, Montreal, Québec, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Krystelle Abalovi
- Centre de recherche en santé publique, Université de Montréal, Montreal, Québec, Canada
| | - Ashley Vandermorris
- Department of Adolescent Medicine, Hospital For Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ève Dubé
- Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
| | - Cat Tuong Nguyen
- Département de médecine, Université de Montréal, Montreal, Quebec, Canada
| | | | - Geneviève Fortin
- Centre de recherche en santé publique, Université de Montréal, Montreal, Québec, Canada
- Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada
| | - Maryam Parvez
- Centre de recherche en santé publique, Université de Montréal, Montreal, Québec, Canada
- Department of Public Health, School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Joyeuse Senga
- Centre de recherche en santé publique, Université de Montréal, Montreal, Québec, Canada
- Department of Public Health, School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | - Joe Abou-Malhab
- Centre de recherche en santé publique, Université de Montréal, Montreal, Québec, Canada
- Department of Public Health, School of Population and Global Health, McGill University, Montreal, Québec, Canada
| | | | - Caroline Quach
- Département de microbiologie et immunologie, Université de Montréal, Montreal, Québec, Canada
- Département de Pédiatrie, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Kate Zinszer
- Centre de recherche en santé publique, Université de Montréal, Montreal, Québec, Canada
- Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada
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Coulibaly A, Touré L, Zinszer K, Ridde V. [The resilience of the Hospital of Mali to COVID-19 in a context of penuries]. Sante Publique 2022; Vol. 33:935-945. [PMID: 35485025 DOI: 10.3917/spub.216.0935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM The objective of this research is to report the strategies of resilience mobilized by the Hospital of Mali to face Coronavirus disease (COVID-19). METHOD The data collected within the hospital covered the first months of the pandemic (April to July 2020). A total of 32 semi-structured interviews and 53 observation sessions were conducted. Data analyses were based on a conceptual framework and were conducted using a deductive approach. RESULTS The results show that, due to the multiple effects of the COVID-19 such as the aggravation of staff penuries, the high workloads, the need to create dedicated infrastructures, the drastic decrease in revenue due to the drop in hospital's attendance, the hospital and its staff implemented multiple strategies (e.g., reduction or postponement of some expenses, requisition of facilities, recruitment of contractual staff and redeployment of some healthcare workers). Those strategies generally allowed to maintain patients access to care, although there were many restrictions for non-COVID-19 patients. The hospital was able to build absorptive resilience. CONCLUSION This qualitative research provides a better understanding of hospitals' resilience processes to the COVID-19 pandemic in a hospital setting. Lessons learned from this study should help hospitals managers to design more appropriate and effective responses to future health crises.
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Mac-Seing M, Zarowsky C, Yuan M, Zinszer K. Disability and sexual and reproductive health service utilisation in Uganda: an intersectional analysis of demographic and health surveys between 2006 and 2016. BMC Public Health 2022; 22:438. [PMID: 35246094 PMCID: PMC8897881 DOI: 10.1186/s12889-022-12708-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 03/28/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background The United Nations through universal health coverage, including sexual and reproductive health (SRH), pledges to include all people, leaving no one behind. However, people with disabilities continue to experience multiple barriers in accessing SRH services. Studies analysing the impacts of disability in conjunction with other social identities and health determinants reveal a complex pattern in SRH service use. Framed within a larger mixed methods study conducted in Uganda, we examined how disability, among other key social determinants of health (SDH), was associated with the use of SRH services. Methods We analysed data from repeated cross-sectional national surveys, the Uganda Demographic and Health Surveys (DHS) of 2006, 2011, and 2016. The three outcomes of interest were antenatal care visits, HIV testing, and modern contraception use. Our main exposure of interest was the type of disability, classified according to six functional dimensions: seeing, hearing, walking/climbing steps, remembering/concentrating, communicating, and self-care. We performed descriptive and multivariable logistic regression analyses, which controlled for covariates such as survey year, sex, age, place of residence, education, and wealth index. Interaction terms between disability and other factors such as sex, education, and wealth index were explored. Regression analyses were informed by an intersectionality framework to highlight social and health disparities within groups. Results From 2006 to 2016, 15.5-18.5% of study participants lived with some form of disability. Over the same period, the overall prevalence of at least four antenatal care visits increased from 48.3 to 61.0%, while overall HIV testing prevalence rose from 30.8 to 92.4% and the overall prevalence of modern contraception use increased from 18.6 to 34.2%. The DHS year, highest education level attained, and wealth index were the most consistent determinants of SRH service utilisation. People with different types of disabilities did not have the same SRH use patterns. Interactions between disability type and wealth index were associated with neither HIV testing nor the use of modern contraception. Women who were wealthy with hearing difficulty (Odds Ratio (OR) = 0.15, 95%CI 0.03 – 0.87) or with communication difficulty (OR = 0.17, 95%CI 0.03 – 0.82) had lower odds of having had optimal antenatal care visits compared to women without disabilities who were poorer. Conclusion This study provided evidence that SRH service use prevalence increased over time in Uganda and highlights the importance of studying SRH and the different disability types when examining SDH. The SDH are pivotal to the attainment of universal health coverage, including SRH services, for all people irrespective of their social identities.
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Affiliation(s)
- Muriel Mac-Seing
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada. .,Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.
| | - Christina Zarowsky
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.,School of Public Health, University of Western Cape, Bellville, South Africa
| | - Mengru Yuan
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Canada.,Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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Ost K, Duquesne L, Duguay C, Traverson L, Mathevet I, Ridde V, Zinszer K. Findings from a scoping review. J Clin Epidemiol 2022; 143:30-60. [PMID: 34823020 PMCID: PMC8607741 DOI: 10.1016/j.jclinepi.2021.11.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 02/15/2021] [Revised: 10/21/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This scoping review aimed to identify how equity has been considered in large-scale infectious disease testing initiatives. STUDY DESIGN AND SETTING Large-scale testing interventions are instrumental for infectious disease control and a central tool for the coronavirus 19 (COVID-19) pandemic. We searched Web of Science: core collection, Embase and Medline in June 2021 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations for scoping reviews. We critically analyzed the content of all included articles. RESULTS Our search resulted in 2448 studies of which 86 were included for data extraction after screening. Of the included articles, 80% reported on COVID-19 -related screening programs. None of the studies presented a formal definition of (in)equity in testing, however, 71 articles did indirectly include elements of equity through the justification of their target population. Of these 71 studies, 58% articles indirectly alluded to health equity according to the PROGRESS-Plus framework, an acronym used to identify a list of socially stratifying characteristics driving inequity in health outcomes. CONCLUSION The studies included in our scoping review did not explicitly consider equity in their design or evaluation which is imperative for the success of infectious disease testing programs.
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Affiliation(s)
- Katarina Ost
- University of Montreal, Département de médecine sociale et préventive, Montreal, Canada,Department of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada,Corresponding author : Tel:. +1-253-231-6341, Fax: 514 343-2207
| | - Louise Duquesne
- University of Montreal, Département de médecine sociale et préventive, Montreal, Canada
| | - Claudia Duguay
- Department of Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada
| | - Lola Traverson
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Isadora Mathevet
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Valéry Ridde
- CEPED, Institute for Research on Sustainable Development, IRD-Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Kate Zinszer
- University of Montreal, Département de médecine sociale et préventive, Montreal, Canada,Centre de recherche en santé publique, Montreal, Canada
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Delesalle L, Sadoine ML, Mediouni S, Denis-Robichaud J, Zinszer K, Zarowsky C, Aenishaenslin C, Carabin H. How are large-scale One Health initiatives targeting infectious diseases and antimicrobial resistance evaluated? A scoping review. One Health 2022; 14:100380. [PMID: 35386427 PMCID: PMC8978269 DOI: 10.1016/j.onehlt.2022.100380] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
While One Health initiatives are gaining in popularity, it is unclear if and how they are evaluated when implementation at scale is intended. The main purpose of this scoping review was to describe how One Health initiatives targeting infectious diseases and antimicrobial resistance at a large scale are evaluated. Secondary objectives included identifying the main facilitators and barriers to the implementation and success of these initiatives, and how their impacts were assessed. Twenty-three studies evaluating One Health initiatives were eligible. Most studies included the human (n = 22) and animal (n = 15) sectors; only four included the environment sector. The types of evaluated initiative (non-exclusive) included governance (n = 5), knowledge (n = 6), protection (n = 17), promotion (n = 16), prevention (n = 9), care (n = 8), advocacy (n = 10) and capacity (n = 10). Studies used normative (n = 4) and evaluative (n = 20) approaches to assess the One Health initiatives, the latter including impact (n = 19), implementation (n = 8), and performance (n = 7) analyses. Structural and economic, social, political, communication and coordination-related factors, as well as ontological factors, were identified as both facilitators and barriers for successful One Health initiatives. These results identified a wide range of evaluation methods and indicators used to demonstrate One Health's added values, strengths, and limitations: the inherent complexity of the One Health approach leads to the use of multiple types of evaluation. The strengths and remaining gaps in the evaluation of such initiative highlight the relevance of comprehensive, mixed-method, context-sensitive evaluation frameworks to inform and support the implementation of One Health initiatives by stakeholders in different governance settings. Studies evaluating One Health initiatives were scarce. Only One Health initiatives related to infectious diseases were evaluated. Evaluations were mainly conducted using quantitative approaches. Involvement of the community was identified as a major facilitator.
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Affiliation(s)
- Léa Delesalle
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
| | - Margaux L. Sadoine
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
| | - Sarah Mediouni
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
| | | | - Kate Zinszer
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
| | - Christina Zarowsky
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
| | - Cécile Aenishaenslin
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
| | - Hélène Carabin
- Département de Pathologie et Microbiologie, Faculté de Médecine Vétérinaire de l'Université de Montréal, Canada
- Département de Médecine Sociale et Préventive, École de Santé Publique de l'Université de Montréal, Canada
- Centre de Recherche en Santé Publique (CReSP), Montréal, Canada
- Groupe de Recherche en Épidémiologie des Zoonoses et Santé Publique (GREZOSP), St-Hyacinthe, Canada
- Corresponding author at: Faculté de Médecine Vétérinaire, 3200 rue Sicotte, Saint-Hyacinthe J2S 2M2, Québec, Canada.
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48
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Côté SM, Geoffroy MC, Haeck C, Ouellet-Morin I, Larose S, Chadi N, Zinszer K, Gauvin L, Mâsse B. Understanding and attenuating pandemic-related disruptions: a plan to reduce inequalities in child development. Can J Public Health 2022; 113:23-35. [PMID: 35089591 PMCID: PMC8796600 DOI: 10.17269/s41997-021-00584-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/01/2022]
Abstract
The Secretary General of the United Nations described the impact of COVID-19-related school closures as a “generational catastrophe.” What will be the legacy of the 2020–2021 pandemic-related disruptions in 5, 10, 20 years from now, as regards education and well-being of children and youth? Addressing the disproportionate impact on those growing up in socio-economically disadvantaged areas or on those with pre-existing learning challenges is key to sustainable recovery. This commentary builds on the four literature reviews presented in this Special Section on a Pandemic Recovery Plan for Children and proposes strategies to understand and attenuate the impact of pandemic-related lockdown measures. Importantly, we need a monitoring strategy to assess indicators of child development in three areas of functioning: education and learning, health, and well-being (or mental health). Surveillance needs to begin in the critical prenatal period (with prenatal care to expectant parents), and extend to the end of formal high school/college education. Based on child development indicators, a stepped strategy for intervention, ranging from all-encompassing population-based health and education promotion initiatives to targeted prevention programs and targeted remedial/therapeutic interventions, can be offered. As proposed in the UN plan for recovery, ensuring healthy present and future generations involves a concerted and intensive intersectoral effort from the education, health, psychosocial services, and scientific communities.
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Affiliation(s)
- Sylvana M Côté
- School of Public Health, Université de Montréal, Montréal, Québec, Canada.
- CHU Sainte-Justine, Montréal, Québec, Canada.
| | - Marie-Claude Geoffroy
- Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
- Douglas Hospital Research Centre, Montréal, Québec, Canada
| | - Catherine Haeck
- Department of Economics, University of Québec in Montréal, Montréal, Québec, Canada
| | | | - Simon Larose
- Département d'études sur l'enseignement et l'apprentissage, Université Laval, Québec, Québec, Canada
| | - Nicholas Chadi
- CHU Sainte-Justine, Montréal, Québec, Canada
- Department of Pediatrics, University of Montreal, Montréal, Québec, Canada
| | - Kate Zinszer
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Lise Gauvin
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche du centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Benoit Mâsse
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- CHU Sainte-Justine, Montréal, Québec, Canada
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49
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Abuzerr S, Zinszer K, Shaheen A, El Bilbeisi AH, Salem A, Aldirawi A, Emad OJ, Al Haj Daoud A, Naser R, Eldeirawi K. Attitudes and Satisfaction toward the Taken Procedures to Tackle COVID-19 Pandemic in Palestine. Ethiop J Health Sci 2022; 32:27-36. [PMID: 35250214 PMCID: PMC8864393 DOI: 10.4314/ejhs.v32i1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/22/2021] [Indexed: 12/21/2022] Open
Abstract
Background Since the beginning of the COVID-19 pandemic, there have been differences in the mitigation strategies implemented by governments worldwide. In addition, people's acceptance and adherence to these strategies, such as avoiding large gatherings and shelter in place, varied. The current study aims to assess the attitude and satisfaction with the procedures to tackle COVID-19 in Palestine. Methods This cross-sectional descriptive study was conducted in the Palestinian territories, including, Gaza Strip, West Bank, and East Jerusalem, between April 29, 2020, and June 5, 2020, using a validated online questionnaire. The questionnaire included three sections: socio-demographic characteristics, attitude towards the measures and behaviors to avoid COVID-19 infection and its consequences, and level of people satisfaction with the response of the community and local authorities to combat the COVID-19 pandemic. A convenience sampling method was used to select participants. Statistical analysis was performed using SPSS version 26. Results A total of 570 adults aged ≥18 years (56.3% males and 43.7% females) were included in the study. The mean positive attitude score (average % agree or strongly agree) was 94.22%; 95.24%, 95.18%, and 92.18% in the Gaza Strip, West Bank, and East Jerusalem, respectively. While, the mean satisfaction score was 44.26%, distributed as 47.16%, 46.1%, and 39.22% in the Gaza Strip, West Bank, and East Jerusalem, respectively. Additionally, there were statistically significant variations by most attitude and satisfaction variables across the governorates included in the study (p < 0.05). The current study demonstrated high levels of positive attitude but suboptimal level of satisfaction toward the taken procedures to tackle COVID-19 in Palestine. Conclusions Varied implementation strategies to improve the levels of satisfaction toward the approaches to combat the COVID-19 pandemic are recommended.
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Affiliation(s)
- Samer Abuzerr
- Visiting Scholar, Department of Social and Preventive Medicine, University of Montreal, Montréal, Canada, Quality Improvement and Infection Control Unit, Ministry of Health, Gaza, Palestine
| | - Kate Zinszer
- School of Public Health, Department of Social and Preventive Medicine, University of Montreal, Canada
| | - Amira Shaheen
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Palestine
| | - Abdel Hamid El Bilbeisi
- Department of Nutrition, School of Medicine and Health Sciences, University of Palestine, Gaza Strip, Palestine
| | | | - Ali Aldirawi
- Pediatric Intensive Care Unit, Al-Shifa Hospital, Ministry of Health, Gaza, Palestine
| | - Osama Jabr Emad
- Mental Health General Directorate, Ministry of Health, Gaza, Palestine
| | - Ayman Al Haj Daoud
- Palestine Academy for Science and Technology (PALAST), West Bank, Palestine
| | | | - Kamal Eldeirawi
- Department of Population Health Nursing Science, UIC College of Nursing (M/C 802), Chicago, USA
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50
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Abuzerr S, Abu-Aita S, Al-Najjar I, Abuhabib A, Al-Jourany H, Zinszer K. Preparedness and Readiness Strategies for Addressing the COVID-19 Pandemic in Fragile and Conflict Settings: Experiences of the Gaza Strip. Front Public Health 2021; 9:766103. [PMID: 34881218 PMCID: PMC8646039 DOI: 10.3389/fpubh.2021.766103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 08/28/2021] [Accepted: 10/28/2021] [Indexed: 12/07/2022] Open
Abstract
The COVID-19 pandemic is a global public health threat of serious concern, especially in conflict settings that face fragility and lack adequate resources and capacities. Gaza suffers from a blockade imposed by the Israeli occupation, environmental deterioration, confiscation of lands, demolition of houses and hospitals, restrictions on movement, lack of control over natural resources, and financial constraints. Gaza's population is consequently living in a poor humanitarian situation with high unemployment rates, poverty, over-crowdedness, and a weak health system. This makes Gaza incredibly fragile and affects its ability to respond to the COVID-19 pandemic effectively. The pandemic is expected to deepen Gaza's systems' fragility, which is already overstretched beyond their limits. This will hinder its capacity to deal with the pandemic, and other pre-existing pressing humanitarian needs. Therefore, in this review, we comprehensively explored Gaza's policy failures and successes related to the COVID-19 preparedness and response by state and non-state actors and recommend potential solutions and alternatives. We have addressed critical issues including the health system, water, sanitation, hygiene, socio-economic, education, food security, and others. In Gaza, effectiveness in combating the COVID-19 pandemic can only come from committed political will, transparency from all regulators, strategic dialogue, comprehensive planning, and active international support.
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Affiliation(s)
- Samer Abuzerr
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, QC, Canada.,Quality Improvement and Infection Control Unit, Ministry of Health, Gaza, Palestine
| | | | - Ismail Al-Najjar
- Disaster and Crisis Management Master Programme, Islamic University of Gaza, Gaza, Palestine
| | - Azzam Abuhabib
- Disaster and Crisis Management Master Programme, Islamic University of Gaza, Gaza, Palestine.,Water Technology Ph.D. Joint Programme, Islamic University of Gaza, Gaza, Palestine
| | | | - Kate Zinszer
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montréal, QC, Canada
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