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Joachim GE, Wagner AL, Naseem M, Boulton ML. Trends in childhood vaccination in Pakistan and associated factors; 2006-2018. Vaccine 2024; 42:795-800. [PMID: 38212203 DOI: 10.1016/j.vaccine.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/14/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Pakistan still has ongoing transmission of wild type polio virus. This study aims to determine changes in full vaccination with recommended Expanded Program on Immunization vaccines, including polio, by several socio-economic and demographic factors. METHODS We used three waves of Pakistan's Demographic and Health Survey, a population-based cross-sectional study from 2006-07 (N = 1471), 2012-13 (N = 1706), and 2017-18 (N = 1549), analyzed by residence, wealth, and sociodemographic factors. Analysis was limited to children aged 12-23 months in Punjab, Sindh, Northwest Frontier Province/Khyber Pakhtunkhwa and Balochistan. Full vaccination was measured as receipt of one Bacillus Calmette-Guérin dose, one measles dose, 3 polio doses, and 3 Diphtheria-Tetanus-Pertussis doses. Odds ratios (ORs) and 95 % confidence intervals (CIs) from logistic regression were used to determine associations between undervaccination and demographic variables. RESULTS Full vaccination coverage was 50.6 % in 2006-07, 54.7 % in 2012-13, and 68.3 % in 2017-18. In 2006-07, the odds of undervaccination were significantly higher in Sindh (OR: 1.74, 95 % CI: 1.30, 2.31) than Punjab, and disparities across province changed over time (P < 0.0001); notably, undervaccination was significantly higher in Sindh, KPK, and Balochistan than Punjab in 2017. Compared to the middle wealth quintile, the poorest had significantly higher odds of undervaccination in 2006-07 (OR: 2.58, 95 % CI: 1.76, 3.78), and this did not significantly change over time (P = 0.2168). The proportion of those with a polio birth dose increased across waves from 56.3 % in 2006-07 to 83.7 % in 2017-18; receiving three or more polio vaccine doses remained unchanged. CONCLUSION This study showed that the proportion of fully vaccinated children in Pakistan increased across three waves. Full vaccination and administration of polio vaccine birth doses have increased recently in Pakistan. The association between undervaccination with province differed significantly across the waves, with vaccination disparities between provinces increasing. Those in the poorest wealth quintile had the greatest odds of undervaccination.
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Affiliation(s)
- Grace E Joachim
- Department of Epidemiology, School of Public Health, University of Michigan, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, USA.
| | | | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, USA; Department of Internal Medicine, Infectious Diseases Division, Michigan Medicine, USA
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Siddiqi DA, Miraj F, Raza H, Hussain OA, Munir M, Dharma VK, Shah MT, Habib A, Chandir S. Development and feasibility testing of an artificially intelligent chatbot to answer immunization-related queries of caregivers in Pakistan: A mixed-methods study. Int J Med Inform 2024; 181:105288. [PMID: 37979501 PMCID: PMC10750258 DOI: 10.1016/j.ijmedinf.2023.105288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/09/2023] [Accepted: 11/07/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Gaps in information access impede immunization uptake, especially in low-resource settings where cutting-edge and innovative digital interventions are limited given the digital inequity. Our objective was to develop an Artificially Intelligent (AI) chatbot to respond to caregiver's immunization-related queries in Pakistan and investigate its feasibility and acceptability in a low-resource, low-literacy setting. METHODS We developed Bablibot (Babybot), a local language immunization chatbot, using Natural Language Processing (NLP) and Machine Learning (ML) technologies with Human in the Loop feature. We evaluated the bot through a sequential mixed-methods study. We enrolled caregivers visiting the 12 selected immunization centers for routine childhood vaccines. Additional caregivers were reached through targeted text message communication. We assessed Bablibot's feasibility and acceptability by tracking user engagement and technological metrics, and through thematic analysis of in-depth interviews with 20 caregivers. FINDINGS Between March 9, 2020, and April 15, 2021, 2,202 caregivers were enrolled in the study, of which, 677 (30.7%) interacted with Bablibot (users). Bablibot responded to 1,877 messages through 874 conversations. Conversation topics included vaccination due dates (32.4%; 283/874), side-effect management (15.7%;137/874), or delaying vaccination due to child's illness or COVID-lockdown (16.8%;147/874). Over 90% (277/307) of responses to text-based exit surveys indicated satisfaction with Bablibot. Qualitative analysis showed caregivers appreciated Bablibot's usefulness and provided feedback for further improvement of the system. CONCLUSION Our results demonstrate the feasibility and acceptability of local-language NLP chatbots in providing real-time immunization information in low-resource settings. Text-based chatbots canminimize the workload on helpline operators, in addition to instantaneously resolving caregiver queries that otherwise lead to delay or default.
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Affiliation(s)
- Danya Arif Siddiqi
- IRD Global, The Great Room, Level 10, One George Street, 049145, Singapore.
| | - Fatima Miraj
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Humdiya Raza
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Owais Ahmed Hussain
- Interactive Health Solutions, 503, Ibrahim Trade Tower, Shahrah-e-Faisal, Karachi, Pakistan
| | - Mehr Munir
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | - Vijay Kumar Dharma
- IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
| | | | - Ali Habib
- Interactive Health Solutions, 503, Ibrahim Trade Tower, Shahrah-e-Faisal, Karachi, Pakistan
| | - Subhash Chandir
- IRD Global, The Great Room, Level 10, One George Street, 049145, Singapore; IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan
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Fasce A, Schmid P, Holford DL, Bates L, Gurevych I, Lewandowsky S. A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling. Nat Hum Behav 2023; 7:1462-1480. [PMID: 37460761 DOI: 10.1038/s41562-023-01644-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/25/2023] [Indexed: 09/23/2023]
Abstract
The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.
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Affiliation(s)
- Angelo Fasce
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Philipp Schmid
- Institute for Planetary Health Behaviour, University of Erfurt, Erfurt, Germany
- Department of Implementation Research, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
| | - Dawn L Holford
- School of Psychological Science, University of Bristol, Bristol, UK
- Department of Psychology, University of Essex, Colchester, UK
| | - Luke Bates
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Iryna Gurevych
- Ubiquitous Knowledge Processing Lab/Department of Computer Science and Hessian Center for AI (hessian.AI), Technical University of Darmstadt, Darmstadt, Germany
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
- Department of Psychology, University of Potsdam, Potsdam, Germany
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Tahir MJ, Zaman M, Saffi J, Asghar MS, Tariq W, Ahmed F, Islam R, Farooqui US, Ullah I, Saqlain M, Ullah K, Ahmed A. Knowledge, attitudes, and practices of the general population of Pakistan regarding typhoid conjugate vaccine: findings of a cross-sectional study. Front Public Health 2023; 11:1151936. [PMID: 37333546 PMCID: PMC10272827 DOI: 10.3389/fpubh.2023.1151936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/28/2023] [Indexed: 06/20/2023] Open
Abstract
Typhoid fever, a common enteric disease in Pakistan, caused by Salmonella typhi, is becoming an extended drug-resistant organism and is preventable through the typhoid conjugate vaccine (TCV). Public adherence to preventive measures is influenced by knowledge and attitude toward the vaccine. This study investigates the knowledge, attitudes, and practices of the general population of Pakistan toward TCV. The differences in mean scores and factors associated with typhoid conjugate vaccine knowledge, attitudes, and practices were investigated. A total of 918 responses were received with a mean age of 25.9 ± 9.6, 51% were women, and 59.6% had graduation-level education. The majority of them responded that vaccines prevent illness (85.3%) and decrease mortality and disability (92.6%), and typhoid could be prevented by vaccination (86.7%). In total, 77.7 and 80.8% considered TCV safe and effective, respectively. Of 389 participants with children, 53.47% had vaccinated children, according to the extended program on immunization (EPI). Higher family income has a higher odds ratio (OR) for willingness toward booster dose of TCV [crude odds ratio (COR) = 4.920, p-value <0.01; adjusted odds ratio (aOR) = 2.853, value of p <0.001], and negative attitude regarding the protective effect of TCV has less willingness toward the booster dose with statistical significance (COR = 0.388, value of p = 0.017; aOR = 0.198, value of p = 0.011). The general population of Pakistan had a good level of knowledge about the benefits of TCV, and attitude and practices are in favor of the usage of TCV. However, a few religious misconceptions are prevalent in public requiring the efforts to overcome them to promote the usage of vaccines to prevent the disease and antibiotic resistance.
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Affiliation(s)
| | - Musharaf Zaman
- Department of Anesthesia, Pakistan Red Crescent Teaching Hospital, Lahore, Pakistan
| | - Junaid Saffi
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Muhammad Sohaib Asghar
- Department of Internal Medicine, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
| | - Waleed Tariq
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Faizan Ahmed
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Rabia Islam
- Department of Medicine, Punjab Medical College, Faisalabad, Pakistan
| | | | - Irfan Ullah
- Department of Medicine, Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, Pakistan
| | - Kaleem Ullah
- Department of Hepatobiliary Surgery and Transplant, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Pakistan
| | - Ali Ahmed
- Department of Pharmacy, School of Pharmacy, Monash University, Subang Jaya, Selangor, Malaysia
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Shahid S, Ahmed S, Qazi MF, Ali R, Ali SA, Zaidi AKM, Iqbal NT, Jehan F, Imran Nisar M. Differential coverage for vaccines in the expanded program on immunization (EPI) among children in rural Pakistan. Vaccine 2023; 41:2680-2689. [PMID: 36933984 PMCID: PMC10124121 DOI: 10.1016/j.vaccine.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Pakistan has a well-established Expanded Program on Immunization (EPI) however vaccine-preventable diseases still account for high infant and child mortality rates. This study describes the differential vaccine coverage and determinants of vaccine uptake in rural Pakistan. METHODS From October 2014 to September 2018, we enrolled children younger than 2 years of age from the Matiari Demographic Surveillance System in Sindh, Pakistan. Socio-demographic and vaccination history were collected from all participants. Vaccine coverage rates and timeliness were reported. Socio-demographic variables for missed and untimely vaccination were studied in multivariable logistic regression. RESULTS Of the 3140 enrolled children, 48.4 % received all EPI recommended vaccines. Only 21.2 % of these were age appropriate. Around 45.4 % of the children were partially vaccinated, and 6.2 % were unvaccinated. Highest coverage was seen for the first dose of pentavalent (72.8 %), 10-valent Pneumococcal Conjugate Vaccine (PCV10) (70.4 %) and Oral Polio Vaccine (OPV) (69.2 %) and the lowest coverage was for measles (29.3 %) and rotavirus (1.8 %) vaccines. Primary caretakers and wage earners with a higher level of education were protective against missed and untimely vaccination. Enrollment in the 2nd, 3rd and 4th study year was negatively associated with being unvaccinated whereas distance from a major road was positively associated with non-adherence to schedule. CONCLUSION Vaccine coverage was low among children in Matiari, Pakistan, and majority received delayed doses. Parents' education status and year of study enrollment was protective against vaccine dropout and delayed vaccination whereas geographical distance from a major road was a predictor. Vaccine promotion and outreach efforts may have had a beneficial impact on vaccine coverage and timeliness.
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Affiliation(s)
- Shahira Shahid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sheraz Ahmed
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Rafey Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syed Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anita K M Zaidi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan; Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Najeeha T Iqbal
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
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Yalçin SS, Kömürlüoğlu A, Topaç O. Rates of childhood vaccine refusal in Turkey during 2016-2017: Regional causes and solutions. Arch Pediatr 2022; 29:594-598. [PMID: 36167616 DOI: 10.1016/j.arcped.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 04/22/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Vaccine hesitancy is a growing problem globally. This study aimed to detect the rates of vaccine refusal (VR) during childhood in each province and region of Turkey from 2016 to 2017 and to evaluate the experiences of Expanded Programme on Immunization (EPI) managers regarding childhood VR and opinions to solve and reduce vaccine hesitancy in Turkey. METHODS VR was defined as the refusal to vaccinate for at least one vaccine in children aged 0-23 months. In this descriptive study, information on notified VR cases and recommended solutions from every province in Turkey was accessed by the local EPI manager for the period 2016-2017. The VR rates were calculated. RESULTS From 80 provinces, 8977 VR cases were detected in 2016 (VR rate 3.5‰) and 14,779 cases in 2017 (VR rate 5.9‰; p<0.001). One quarter of Family Health Units reported at least one case of VR. The highest VR rate in children aged under 2 years was in East Marmara (8.4‰) in 2016, and the West Anatolia Region (10.9‰) and East Marmara region (10.9‰) in 2017. Concerns about the vaccine content, harmfulness, and fears about adverse effects were the most common reasons underlying VR. Educating healthcare workers about vaccines and interpersonal communication skills, increasing patient information with informative brochures, and preventing anti-vaccination publications in the media were the most frequent recommendations to solve VR. CONCLUSIONS In Turkey, VR cases continue to increase. Correct and adequate information, effective communication, and trust between healthcare workers and parents can help reduce VR.
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Affiliation(s)
- Siddika Songül Yalçin
- Hacettepe University, Faculty of Medicine, Department of Pediatrics, Division of Social Pediatrics, Ankara, Turkey.
| | - Ayça Kömürlüoğlu
- Sivas Cumhuriyet University, Faculty of Medicine, Department of Pediatrics, Sivas, Turkey
| | - Osman Topaç
- Ankara Health Directorate Public Health Presidency, Ankara, Turkey
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Khattak S, Idrees M, Iqbal HI, Khan M, Assad N, Khan MN, Yousaf MT, Farooq M, Yang CY, Wu DD, Ji XY. Assessment of Attitudes and Intentions towards COVID-19 Vaccines and Associated Factors among General Populations of Pakistan: A Cross-Sectional Study. Vaccines (Basel) 2022; 10:1583. [PMID: 36298447 PMCID: PMC9609017 DOI: 10.3390/vaccines10101583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/07/2022] [Accepted: 09/15/2022] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE The goal of public health in combatting COVID-19 is to increase herd immunity. However, vaccine reluctance makes attaining herd immunity a worldwide challenge. This investigation aimed to identify negative and positive attitudes and intentions about COVID-19 vaccinations. METHODS A cross-sectional online survey was conducted once free COVID-19 vaccines became available in Pakistan in 2021. 4392 Pakistanis aged 18 and older were surveyed from seven administrative units between 1 July and 30 August 2021. Online structured questionnaires were utilized to collect data using a simple sampling procedure. The questionnaires were divided into three major sections: sociodemographic, health factors, and attitudes toward COVID-19. RESULTS The survey link was shared with approximately 4500 participants. 97.6%(4392) completed the survey once begun. Frequency, percentage and Chi-square tests were used to analyze statistical data. Most of the participants in the research were men (2703 (61.54%)), 3277 (74.61%) were aged 18-29 years, and 1824 (41.53%) were residents of the Khyber Pakhtunkhwa province. (18.69%) Respondents expressed COVID-19 vaccine hesitancy, whereas 36.66% of participants liked getting the Sinopharm and Sinovac vaccines and (35.84%) of participants preferred the Pfizer vaccine. A significant number of participants (38.05%) were concerned about the vaccine's unexpected side effects Thus, it is essential to realize that many participants were concerned about the vaccine's unexpected side effects. CONCLUSIONS The overall high level of concern about the unforeseen side effects of COVID-19 vaccines, as well as widespread vaccine hesitancy among Pakistani populations and its predictors, should be taken into account if public health intervention campaigns in Pakistan are changing negative attitudes and improving compliance with regard to COVID-19 vaccines.
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Affiliation(s)
- Saadullah Khattak
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
- School of Life Sciences, Henan University, Kaifeng 475004, China
| | - Muhammad Idrees
- Primary and Secondary Health Care Department, Lahore 54000, Pakistan
| | - Hafiza Iqra Iqbal
- Primary and Secondary Health Care Department, Lahore 54000, Pakistan
| | - Maqbool Khan
- Sino-Pak Center for Artificial Intelligence, Pak-Austria Fachhochschule: Institute of Applied Sciences and Technology, Haripur 22620, Pakistan
| | - Nasir Assad
- Institute of Chemistry, University of Sargodha, Sargodha 40100, Pakistan
| | - Muhammad Naeem Khan
- School of Social and Behavioral Sciences, Nanjing University, Nanjing 210023, China
| | - Muhammad Tufail Yousaf
- Institute of Microbiology, Faculty of Veterinary and Animal Sciences, Gomal University, Dera Ismail Khan 29111, Pakistan
| | - Muhammad Farooq
- Department of Microbiology, University of Swabi, Swabi 23430, Pakistan
| | - Chang-Yong Yang
- School of Nursing and Health, Henan University, Kaifeng 475004, China
| | - Dong-Dong Wu
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
- School of Stomatology, Henan University, Kaifeng 475004, China
| | - Xin-Ying Ji
- Henan International Joint Laboratory for Nuclear Protein Regulation, School of Basic Medical Sciences, Henan University, Kaifeng 475004, China
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Khaliq A, Elahi AA, Zahid A, Lassi ZS. A Survey Exploring Reasons behind Immunization Refusal among the Parents and Caregivers of Children under Two Years Living in Urban Slums of Karachi, Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11631. [PMID: 36141905 PMCID: PMC9516974 DOI: 10.3390/ijerph191811631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/05/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
This study assesses the experiences of parents/caregivers regarding the refusal to childhood immunization. A cross-sectional study was conducted among the parents/caregivers of children under two years old from January 2019 to June 2019 who were residents of either Pathan Colony or Orangi Town, Karachi. In this study, the data collectors targeted parents/caregivers of 440 households who showed a refusal mark "R" in the Expanded Program of Immunization (EPI) H-chalking system. These households were approached using a 30 × 7 multistage-stratified-cluster random sampling technique and were interviewed using a structured questionnaire. The study sample produced two different types of refusals: true refusal (absence) and potential refusal (presence), based on the absence and presence of a vaccination card at the time of the survey. Multivariate logistic regression was used to analyze the data using Jamovi (V-1.6.13). A total of 230 households consented to participate in this study, of which 141 (61.3%) represented true refusals, while 89 (38.7%) represented potential refusals. More than half of the participants from both groups complained about fever and pain at the injection site following immunization. The use of alternative medicines and a history of adverse events following immunization (AEFI) were associated with increasing the odds of immunization refusals by four-to-five fold. However, advanced paternal age, a long distance to the clinic, a lack of trust in government, and the influence of community/religious leaders were associated with lower immunization refusal odds. Thus, an unawareness about self-limiting vaccine-related adverse events, the use of alternative medicines, and an increased concern about the safety and efficacy of vaccines were found to be barriers to immunization, which can be improved by increasing public awareness through media campaigns and policy reform.
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Affiliation(s)
- Asif Khaliq
- Department of Health & Hospital Management, Institute of Business Management, Karachi 75190, Pakistan
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Alfaraz Ashraf Elahi
- Department of Health & Hospital Management, Institute of Business Management, Karachi 75190, Pakistan
| | - Asima Zahid
- Department of Health & Hospital Management, Institute of Business Management, Karachi 75190, Pakistan
| | - Zohra S. Lassi
- Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia
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Jiang N, Gu P, Sun X, Han H, Liu W, Song N, Jiang X. Acceptance of COVID‐19 vaccines in patients with chronic diseases: A cross‐sectional study. J Clin Nurs 2022; 31:3286-3300. [PMID: 35285111 PMCID: PMC9115274 DOI: 10.1111/jocn.16284] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/22/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023]
Abstract
Aims and objectives This study aimed to clarify the attitudes, knowledge and vaccination willingness of patients with chronic diseases toward COVID‐19 vaccines and the influencing factors. Background Vaccination against COVID‐19 is an important way to protect patients with chronic diseases, but the vaccination acceptance varies across diseases and populations. A better understanding of this condition will lead to tailored intervention strategies and high vaccination rates. Design Cross‐sectional study. Methods Data were collected between March 2021 and May 2021 in China. A self‐compiled questionnaire was used in the survey. Two independent‐samples t‐tests/one‐way analysis of variance or U test/H test was used to measure the differences between groups. Multivariate regression analysis was used to identify the influencing factors. The study adhered to the EQUATOR checklist, STROBE. Results A total of 998 patients participated in the study. Score rates of attitudes, knowledge and vaccination willingness were 69.9%, 68.4% and 70.6% respectively. Age, vaccination status of family members, education levels, vaccine side effects and economic level were positive factors that could influence patients’ vaccination acceptances, while time of illness, type of disease and political affiliations were negative predictors. The top reasons for willingness toward vaccination were supporting national strategies, belief on the vaccines and fearing of contracting COVID‐19, while physical reasons, side effects and having a wait‐and‐see attitude were unwillingness factors. Conclusions Patients’ attitudes, knowledge and vaccination willingness were medium. Nurses should pay attention to patients who are from lower socioeconomic backgrounds, under 30 or over 70 years old, have no political affiliations, have damage to vital organs, have a long course of illness, family members have not received COVID‐19 vaccines and had no side effects after receiving other vaccines. Relevance to clinical practice Clinical nurses are recommended to take measures from patients’ duration of illness, damaged organs, demographic characteristics and families to improve patients’ vaccination acceptances.
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Affiliation(s)
- Ning Jiang
- West China School of Nursing/West China Hospital Sichuan University Chengdu China
- School of Nursing Shandong First Medical University Taian China
| | - Pengfei Gu
- School of Foreign Languages Shandong First Medical University Taian China
| | - Xian Sun
- Neurology Department Tianjin Third Central Hospital Tianjin China
| | - Hui Han
- Department of Gynecologic Oncology Tai’ an City Tumor Prevention Hospital Taian China
| | - Wenwen Liu
- Department of Respiratory Medicine Joint Logistic Support Force of the People's Liberation Army Taian China
| | - Na Song
- Department of Hemodialysis Joint Logistic Support Force of the People's Liberation Army Taian China
| | - Xiaolian Jiang
- West China School of Nursing/West China Hospital Sichuan University Chengdu China
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Ezezika O, Mengistu M, Opoku E, Farheen A, Chauhan A, Barrett K. What are the barriers and facilitators to polio vaccination and eradication programs? A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001283. [PMID: 36962654 PMCID: PMC10022167 DOI: 10.1371/journal.pgph.0001283] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
Global efforts to eradicate polio by the Global Polio Eradication Initiative agency partners and country-level stakeholders have led to the implementation of global polio vaccination programs. This study presents the findings of existing studies regarding the barriers and facilitators that countries face when implementing polio interventions. A comprehensive search was conducted in OVID Medline, OVID Embase, EBSCO CINAHL Plus, and Web of Science. Eligible studies underwent quality assessment. A qualitative evidence synthesis approach was conducted and aligned to the Consolidated Framework for Implementation Research (CFIR). The search identified 4147 citations, and following the removal of duplicates and screening according to our inclusion/exclusion criteria, 20 articles were eligible for inclusion in the review. Twelve countries were represented in this review, with India, Nigeria, Pakistan, Ethiopia, and Afghanistan having the most representation of available studies. We identified 36 barriers and 16 facilitators. Seven themes emerged from these barriers and facilitators: fear, community trust, infrastructure, beliefs about the intervention, influential opinions, intervention design, and geo-politics. The most frequently cited CFIR constructs for the facilitators and barriers were knowledge and beliefs about the intervention, followed by available resources. This study identified a wide range of barriers and facilitators to polio vaccination implementation across the globe, adding to the scarce body of literature on these barriers and facilitators from an implementation perspective and using a determinant framework. The diversity of factors among different groups of people or countries highlights the relevance of contexts. Implementers should be conversant with the contexts within which polio eradication programs boost intervention coverage and capacity. This study provides policymakers, practitioners, and researchers with a tool for planning and designing polio immunization programs. Trial registration: A protocol for this systematic review was developed and uploaded onto the PROSPERO international prospective register of systematic reviews database (Registration number: CRD42020222115).
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Affiliation(s)
- Obidimma Ezezika
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- African Centre for Innovation and Leadership Development, Abuja, Nigeria
| | - Meron Mengistu
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- London School of Hygiene & Tropical Medicine, Keppel St, London, United Kingdom
| | - Eric Opoku
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Aiman Farheen
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Anuradha Chauhan
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Kathryn Barrett
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
- University of Toronto Scarborough Library, Toronto, Canada
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11
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Cooper S, Schmidt BM, Sambala EZ, Swartz A, Colvin CJ, Leon N, Wiysonge CS. Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis. Cochrane Database Syst Rev 2021; 10:CD013265. [PMID: 34706066 PMCID: PMC8550333 DOI: 10.1002/14651858.cd013265.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. OBJECTIVES - Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. SELECTION CRITERIA We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. DATA COLLECTION AND ANALYSIS We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review. MAIN RESULTS We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness. AUTHORS' CONCLUSIONS Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.
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Affiliation(s)
- Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Evanson Z Sambala
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Alison Swartz
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christopher J Colvin
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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12
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Khan MD. Toward creating equity in access to COVID-19 vaccination for female population in Multan, Punjab, Pakistan. Health Care Women Int 2021:1-10. [PMID: 34686113 DOI: 10.1080/07399332.2021.1988952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
The researchers examined the access to the COVID-19 vaccine among 32 females in Multan, Punjab, Pakistan. The aim of the study is to access the independence of decision-making among female participants to vaccinate themselves against the COVID-19. Participants of the study belong to Multan, a city of Southern Punjab. The researchers adopt a qualitative research design, using in-depth interviews, repeated open-ended questions, and local languages. Among general conclusions of this study are, female dependence on male members to get the vaccination, limited control on deciding the need for vaccination, and patriarchal decision to vaccinate the family. The aim of the researchers is to contribute toward an effective COVID-19 vaccination campaign by minimizing discrimination against women in accessing the vaccine.
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Affiliation(s)
- Muhammad Danyal Khan
- Faculty of Commerce Law and Business Administration, Bahauddin Zakariya University, Multan, Pakistan
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13
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DInur-Schejter Y, Stepensky P. Social determinants of health and primary immunodeficiency. Ann Allergy Asthma Immunol 2021; 128:12-18. [PMID: 34628007 DOI: 10.1016/j.anai.2021.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Inborn errors of immunity (IEI) are rare genetic conditions affecting the immune system. The rate of IEI and their presentation, course, and treatment are all affected by a multitude of social determinants, eventually affecting prognosis. This review summarizes the current knowledge of the social determinants affecting infectious susceptibility, genetic predisposition, diagnosis, and treatment of IEI. DATA SOURCES PubMed. STUDY SELECTIONS Search terms included "consanguinity," "social determinants," and "founder effect." Further studies were selected based on relevant citations. RESULTS Changes in climate and human behavior have modulated the spread of disease vectors and infectious organisms. Consanguinity increases the rate of autosomal recessive conditions, changes the distribution, and affects the severity of IEI. Access to sophisticated genetic and immunologic diagnostic modalities affects genetic counseling and timely diagnosis. Effective genetic counseling should address to the patient's genetic background and ethical code. Access to appropriate and timely treatment of immunodeficiencies is scarce in some regions of the world. CONCLUSION High consanguinity rate and reduced access to prophylactic measures increase the burden of immunodeficiencies in many low- and medium-income countries. Furthermore, poor access to diagnostic and treatment modalities in these regions adversely affects patients' prognosis. Increased awareness among health care professionals and the public and increased collaboration with Western countries aid in diagnosis of these conditions. Further advancements require improved public funding to the prevention, diagnosis, and treatment of IEI.
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Affiliation(s)
- Yael DInur-Schejter
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel; Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah Ein Kerem Medical Center, Jerusalem, Israel.
| | - Polina Stepensky
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel; Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
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14
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Tahir MJ, Saqlain M, Tariq W, Waheed S, Tan SHS, Nasir SI, Ullah I, Ahmed A. Population preferences and attitudes towards COVID-19 vaccination: a cross-sectional study from Pakistan. BMC Public Health 2021; 21:1759. [PMID: 34565351 PMCID: PMC8474768 DOI: 10.1186/s12889-021-11814-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/17/2021] [Indexed: 12/23/2022] Open
Abstract
Background While vaccine development is itself a challenge; ensuring optimal vaccine uptake at population level can present an even more significant challenge. Therefore, this study aimed to assess the Pakistani population’s attitude and preferences towards the Coronavirus disease 2019 (COVID-19) vaccine. Method A cross-sectional study was carried out through an online self-administered questionnaire from 27 September 2020 to 11 October 2020. A total of 883 people responded to the survey. The questionnaire included the participants’ socio-demographic variables, attitudes, beliefs towards the COVID-19 vaccine and acceptance and rejection of vaccination, and reasons for them. Logistic regression analysis was used to analyze the predictors for vaccine acceptance and willingness to pay for the vaccine. Results A majority (70.8%) of respondents will accept the COVID-19vaccine if available, and 66.8% showed a positive attitude towards vaccination. Monthly family income, education level, self-diagnosis of COVID-19 or a friend, family member, or colleague are significant factors influencing the acceptance of COVID-19 vaccination. The dogma of being naturally immune to COVID-19 was a key reason for the refusal of the vaccine. Less than half (48%) of those who refuse will vaccinate themselves if government officials have made it compulsory. A third (33.9%) of participants were willing to pay up to (7 USD) 1000 Pkr (Pakistani Rupees) for the vaccine. Conclusion The population’s positive attitude should be improved by increasing awareness and eradicating false myths about vaccines through large-scale campaigns. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11814-5.
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Affiliation(s)
- Muhammad Junaid Tahir
- Ameer-ud-Din Medical College Affiliated with University of Health Sciences, Lahore, 54000, Pakistan.,Lahore General Hospital, Lahore, 54000, Pakistan
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, 45320, Pakistan
| | - Waleed Tariq
- Ameer-ud-Din Medical College Affiliated with University of Health Sciences, Lahore, 54000, Pakistan.,Lahore General Hospital, Lahore, 54000, Pakistan
| | - Summaiya Waheed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Steven H S Tan
- Newcastle University Medicine Malaysia, Nusajaya, Malaysia
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Ali Ahmed
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, 45320, Pakistan. .,School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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15
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Kasrine Al Halabi C, Obeid S, Sacre H, Akel M, Hallit R, Salameh P, Hallit S. Attitudes of Lebanese adults regarding COVID-19 vaccination. BMC Public Health 2021; 21:998. [PMID: 34044790 PMCID: PMC8156575 DOI: 10.1186/s12889-021-10902-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND COVID-19 was first detected in Lebanon on February 21, 2020; it reached its peak in January 2021, with a total number of 418,448 confirmed cases and 5380 deaths (until March 15, 2021). Gaining insight into factors regarding willingness or refusal for vaccination might guide our goals in raising the awareness and target efforts to increase acceptance of the COVID-19 vaccine and maximize the uptake. Therefore, this study aims to assess the intent to receive the COVID-19 vaccine among Lebanese adults and the factors associated with vaccine refusal. METHODS We conducted a cross-sectional study during November-December 2020 among Lebanese adults from all Lebanese regions using a survey tool with closed-ended questions that included sociodemographic data and questions about vaccine hesitancy, knowledge, attitude, practice, and fear of COVID-19. We used the snowball technique to collect the data because of the COVID-19 imposed lockdown. RESULTS Of the 579 participants, 21.4% were willing to receive the vaccine, 40.9% refused, and the remainder were unsure of their response. More vaccine hesitancy (adjusted odds ratio (aOR) = 1.06; 95% CI 1.03-1.09) was significantly associated with more odds of disagreeing/ strongly disagreeing on receiving the COVID-19 vaccine compared to being neutral. More vaccine hesitancy (aOR = 0.95; 95% CI 0.91-0.99), female gender compared to males (aOR = 0.53; 95% CI 0.32-0.87), and being married compared to single (aOR = 0.53; 95% CI 0.29-0.98) were significantly associated with lower odds of agreeing/strongly agreeing on receiving the COVID-19 vaccine compared to being neutral. CONCLUSION Overall, our findings revealed a high percentage of people (40%) who strongly disagreed with receiving the vaccine, mainly females, married participants, and those who have a general vaccine hesitancy. Moreover, no significant association was found with knowledge, attitude, or prevention practice regarding COVID-19. Targeted efforts are necessary to increase acceptance of a COVID-19 vaccine among the Lebanese population to control the COVID-19 pandemic. Further studies with a larger sample size are warranted to validate our results and provide better insights into the underlying reasons for refusing vaccination.
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Affiliation(s)
- Carina Kasrine Al Halabi
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Sahar Obeid
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,Research and Psychology Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Marwan Akel
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Infectious Disease Department, Bellevue Medical Center, Mansourieh, Lebanon.,Infectious Disease Department, Notre-Dame des Secours University Hospital, Byblos, Cyprus
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.,University of Nicosia Medical School, Nicosia, Cyprus
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon.
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16
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Khan MS, Ali SAM, Adelaine A, Karan A. Rethinking vaccine hesitancy among minority groups. Lancet 2021; 397:1863-1865. [PMID: 33894143 PMCID: PMC8059987 DOI: 10.1016/s0140-6736(21)00938-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Mishal S Khan
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; Departments of Community Health Sciences and Pathology, Aga Khan University, Karachi, Pakistan.
| | - Sameen A Mohsin Ali
- Department of Humanities and Social Sciences, Lahore University of Management Sciences, Lahore, Pakistan
| | | | - Abraar Karan
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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17
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Ataullahjan A, Ahsan H, Soofi S, Habib MA, Bhutta ZA. Eradicating polio in Pakistan: a systematic review of programs and policies. Expert Rev Vaccines 2021; 20:661-678. [PMID: 33896306 DOI: 10.1080/14760584.2021.1915139] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Established in 1994, Pakistan's polio program demonstrated early success. However, despite over 120 supplementary immunization activities in the last decade, polio eradication efforts in Pakistan have been unable to achieve their objective of halting polio transmission. Variable governance, and inconsistent leadership and accountability have hindered the success of the polio program and the quality of the campaigns. Insecurity and terrorism has interrupted polio activities, and community fears and misbeliefs about polio vaccinations continue to persist.Areas covered: The article consists of a systematic review of the barriers and facilitators associated with the delivery of polio eradication activities in Pakistan. We also provide a comprehensive review of the policy and programmatic decisions made by the Pakistan Polio Programme since 1994. Searches were conducted on Embase and Medline databases and 25 gray literature sources.Expert opinion: Polio eradication efforts must be integrated with other preventive health services, particularly immunization services. Addressing the underlying causes of polio refusals including underdevelopment and social exclusion will help counteract resistance to polio vaccination. Achieving polio eradication will require building health systems that provide comprehensive community-centered care, and improving governance and systems of accountability.
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Affiliation(s)
- Anushka Ataullahjan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Hanaa Ahsan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Sajid Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Muhammad Atif Habib
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada.,Centre of Excellence in Women and Child Health, Aga Khan University South-Central Asia, East Africa & United Kingdom
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18
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Yang X, Tang T, Yang Z, Liu L, Yuan S, Zhang T. Evaluation of measles vaccination coverage in Lincang City, Yunnan Province, China. Hum Vaccin Immunother 2021; 17:3145-3152. [PMID: 33847247 DOI: 10.1080/21645515.2021.1911215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Lincang City in Yunnan Province on the China-Myanmar border, has reached the World Health Organization recommended coverage (95%) for measles-containing vaccine (MCV), but measles outbreaks still occur. We conducted a survey in Lincang City to determine the measles vaccination status of children on the China-Myanmar border.Methods: We used multistage sampling among children aged 8-83 months. Information on measles vaccination status was obtained from the child's vaccination certificate, and serum samples were tested using commercially available ELISA kits.Results: A total of 938 children were surveyed. The vaccination coverage rate was 98.9% (95% CI: 98.2-99.6%) for measles-containing vaccine dose 1 (MCV1), and 95.8% (95% CI:94.9-96.7%) for measles-containing vaccine dose 2 (MCV2). The timely vaccination coverage rate was 52.0% (95% CI:48.8-55.2%) for MCV1, and 74.1% (95% CI: 82.9-89.0%) for MCV2. The timely-and-complete vaccination coverage rate was 41.0% (95% CI: 36.7-45.3%). The median delay period was 33 (95% CI: 27-39) days for MCV1, and 196 (95% CI: 146-246) days for MCV2. The seropositivity rate in children aged less than 7 years was 94.0% (95% CI: 92.5-95.5%) with a geometric mean titer of 1210.1 mIU/mL.Conclusions: The MCV coverage was high, but timely and timely-and-complete vaccination coverage were low and insufficient to prevent measles outbreaks. It is necessary to add the timely and timely-and-complete vaccination coverage as indicators of vaccination to provide a more complete picture of measles immunization status.
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Affiliation(s)
- Xiaotong Yang
- Epidemiology and Biostatistics Unit, Faculty of Public Health, Dali University, Dali, China
| | - Tingting Tang
- Department of Expanded Program on Immunization, Yunnan Center for Disease Control and Prevention, Kunming, China
| | - Zhikang Yang
- Epidemiology and Biostatistics Unit, Faculty of Public Health, Dali University, Dali, China
| | - Lu Liu
- Epidemiology and Biostatistics Unit, Faculty of Public Health, Dali University, Dali, China
| | - Shuyi Yuan
- Expanded Program on Immunization Department, Lincang Center for Disease Control and Prevention, Lincang City, China
| | - Tai Zhang
- Epidemiology and Biostatistics Unit, Faculty of Public Health, Dali University, Dali, China
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19
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Cutts FT, Ferrari MJ, Krause LK, Tatem AJ, Mosser JF. Vaccination strategies for measles control and elimination: time to strengthen local initiatives. BMC Med 2021; 19:2. [PMID: 33397366 PMCID: PMC7781821 DOI: 10.1186/s12916-020-01843-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Through a combination of strong routine immunization (RI), strategic supplemental immunization activities (SIA) and robust surveillance, numerous countries have been able to approach or achieve measles elimination. The fragility of these achievements has been shown, however, by the resurgence of measles since 2016. We describe trends in routine measles vaccine coverage at national and district level, SIA performance and demographic changes in the three regions with the highest measles burden. FINDINGS WHO-UNICEF estimates of immunization coverage show that global coverage of the first dose of measles vaccine has stabilized at 85% from 2015 to 19. In 2000, 17 countries in the WHO African and Eastern Mediterranean regions had measles vaccine coverage below 50%, and although all increased coverage by 2019, at a median of 60%, it remained far below levels needed for elimination. Geospatial estimates show many low coverage districts across Africa and much of the Eastern Mediterranean and southeast Asian regions. A large proportion of children unvaccinated for MCV live in conflict-affected areas with remote rural areas and some urban areas also at risk. Countries with low RI coverage use SIAs frequently, yet the ideal timing and target age range for SIAs vary within countries, and the impact of SIAs has often been mitigated by delays or disruptions. SIAs have not been sufficient to achieve or sustain measles elimination in the countries with weakest routine systems. Demographic changes also affect measles transmission, and their variation between and within countries should be incorporated into strategic planning. CONCLUSIONS Rebuilding services after the COVID-19 pandemic provides a need and an opportunity to increase community engagement in planning and monitoring services. A broader suite of interventions is needed beyond SIAs. Improved methods for tracking coverage at the individual and community level are needed together with enhanced surveillance. Decision-making needs to be decentralized to develop locally-driven, sustainable strategies for measles control and elimination.
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Affiliation(s)
- F T Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - M J Ferrari
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA
| | - L K Krause
- Vaccine Delivery, Global Development, The Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - A J Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - J F Mosser
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, 98121, USA
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20
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Chang WH. A review of vaccine effects on women in light of the COVID-19 pandemic. Taiwan J Obstet Gynecol 2020; 59:812-820. [PMID: 33218394 PMCID: PMC7486065 DOI: 10.1016/j.tjog.2020.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
The pandemic situation triggered by the spread of COVID-19 has caused great harm worldwide. More than six million people have been infected, and more than 360,000 of them have died. This is the worst catastrophe suffered by mankind in recent history. In the face of this severe disaster, people all over the world are frightened of the prospect of facing an outbreak or an annual recurrence. However, the development of a vaccine will help control the impact of COVID-19. Women in particular have been more seriously affected by the pandemic. Since the pressure and physical load they suffer are often greater than what men endure, women are more threatened by COVID-19. Though women have a poorer quality of life and work and face worse economic conditions, they also tend to have better physiological immunity than men, which can ease the effect of COVID-19. The early development of a vaccine against COVID-19 is an important issue that must take into consideration women's better immune response to the virus along with the technique of hormone regulation. Relevant research has been conducted on female-specific vaccines in the past, and women's issues were considered during those clinical trials to ensure that complications and antibody responses were positive and effective in women. National policies should also propose good strategies for women to be vaccinated. This could improve consciousness, give women a better vaccination experience, enhance their willingness to vaccinate, and protect them from COVID-19 infection.
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Affiliation(s)
- Wen-Han Chang
- Department of Medicine, Mackay Medical College, New Taipei, Taiwan; Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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