An examination of Thailand's health care system and strategies during the management of the COVID-19 pandemic

The Perspectives of Healthcare Professionals on the Strategies, Challenges, and Community Responses to Health System Response and Interventions Towards Lassa Fever Infections and Mortality in Sierra Leone

Background

Lassa fever is a critical public health issue in Sierra Leone that demands appropriate health system responses and interventions to mitigate infections and reduce mortality.

Methods

A qualitative study was conducted to delve into healthcare workers' experiences with Lassa fever management and interventions across diverse healthcare settings in Sierra Leone, including the Eastern Province and Freetown's Directorate of Health Security and Emergency (DHSE). Engaging ten key informants through purposive sampling, the study employed NVivo version 10 for a detailed thematic analysis using Query and Coding to systematically identify, classify, and organize key themes regarding knowledge, diagnostics, management roles, and community impact.

Results

The findings indicate a well-informed healthcare workforce but highlight gaps in early detection, diagnostic accuracy, and procedural standardization. Concerns were raised about the potential overestimation of disease incidence due to improved diagnostics, suggesting a historical under-detection of Lassa fever. The analysis underscores the need for a multifaceted management approach, emphasizing international collaboration and culturally sensitive community engagement to effectively tackle the disease. A significant concern identified is the high mortality rate resulting from delayed referrals and communication challenges within the health system, leading to actionable recommendations for enhancing Lassa fever response strategies. The study's thematic analysis provides a nuanced understanding of the challenges and areas for improvement, emphasizing the critical role of healthcare professionals in combating Lassa fever.

Conclusion

Combating Lassa fever in Sierra Leone demands an integrative strategy that extends beyond medical interventions to encompass educational and infrastructural enhancements. This research pays homage to the commitment of healthcare professionals, underscoring the importance of sustained support and recognition of their essential contributions to advancing Lassa fever management and interventions.

The National Early Warning Score 2 with Age and Body Mass Index (NEWS2 Plus) to Determine Patients with Severe COVID-19 Pneumonia

(1) Background: Early identification of severe coronavirus disease 2019 (COVID-19) pneumonia at the initial phase of hospitalization is very crucial. To address this, we validated and updated the National Early Warning Score 2 (NEWS2) for this purpose. (2) Methods: We conducted a study on adult patients with COVID-19 infection in Chiang Mai, Thailand, between May 2021 and October 2021. (3) Results: From a total of 725 COVID-19 adult patients, 350 (48.3%) patients suffered severe COVID-19 pneumonia. In determining severe COVID-19 pneumonia, NEWS2 and NEWS2 + Age + BMI (NEWS2 Plus) showed the C-statistic values of 0.798 (95% CI, 0.767-0.830) and 0.821 (95% CI, 0.791-0.850), respectively. The C-statistic values of NEWS2 Plus were significantly improved compared to those of NEWS2 alone (p = 0.012). Utilizing a cut-off point of five, NEWS2 Plus exhibited better sensitivity and negative predictive value than the traditional NEWS2, with values of 99.7% vs. 83.7% and 98.9% vs. 80.7%, respectively. (4) Conclusions: The incorporation of age and BMI into the traditional NEWS2 score enhanced the efficacy of determining severe COVID-19 pneumonia. Physicians can rely on NEWS2 Plus (NEWS2 + Age + BMI) as a more effective decision-making tool for triaging COVID-19 patients during early hospitalization.

Differences in clinical manifestations between cases stung by single-tentacle and multiple-tentacle box jellyfish over two decades

There are no routine laboratory investigations to identify jellyfish species and toxins in Thailand. Distinguishing clinical manifestation is important for medical care and also recommendations for the population. This study aimed to describe the clinical manifestations of box jellyfish stinging cases and determine differences between cases stung by single- (SBJ) and multiple-tentacle box jellyfish (MBJ). This retrospective study was conducted in Thailand. Data regarding injuries and deaths eligible for inclusion were those pertinent to stinging by box jellyfish under the National Surveillance System of Injuries and Deaths Caused by Toxic Jellyfish. All cases detected by the Toxic Jellyfish Networks were investigated. There were 29 SBJ, 92 MBJ, and 3 SBJ/or MBJ cases in the period 1999 to 2021. In about half of the cases in each group had abnormal heart rates and about one-third had respiratory distress. The SBJ group had a high proportion of pain in the other parts of the body (38.2%), abdominal cramps (13.8%), fatigue (24.1%), anxiety/agitation (24.1%), and there was no death. The MBJ group had a high proportion of severe pain and severe burning pain at the site of the wounds (44.3%), swelling/edema at the affected organs/areas (46.8%), collapse/near-collapse (30.4%), worse outcomes (9.8%), and 9.8% deaths. In comparison to the MBJ group, the SBJ group were 13.4 times (95% Confidence Intervals of Relative Risk: 4.9, 36.6) and 6.1 times (1.2, 31.4) more likely to have pain in other parts of the body and abdominal cramps, subsequently. MBJ group was 1.8 times (1.4, 2.2) more likely to have pain at wounds than the SBJ group. Some initial symptoms might make health professionals misdiagnose SBJ as MBJ stinging. The Irukandji-like syndrome that appeared later among SBJ cases is the clue for correct diagnosis. These results are useful for the improvement of diagnosis, medical care, and surveillance.

Factors Influencing the Antenatal Care Attendance of Pregnant Women During the First COVID-19 Wave Lockdown in Thailand

Background

The coronavirus disease 2019 (COVID-19) outbreak impacted healthcare service management worldwide. Thailand had limited healthcare resources. During the pandemic, several medical supplies were in high demand and expensive. The Thai government needed to declare a lockdown to reduce the unnecessary use of medical supplies. Antenatal care (ANC) services have adapted to the outbreak situation. However, information about the potential impact of COVID-19 lockdown on pregnant women and the reduction of disease exposure risk in this population remains unclear. Thus, this study aimed to assess the percentage of ANC attendance and factors affecting the scheduled ANC attendance of pregnant women during the first COVID-19 wave lockdown in Thailand.

Methods

This retrospective cross-sectional study included Thai women who were pregnant between 1 March and 31 May 2020. An online survey was conducted among pregnant women who had first ever ANC attendance before 1 March 2020. A total of 266 completed responses were returned and analysed. Statistically, the sample size was representative of the population. The predictors of scheduled ANC attendance during the lockdown were identified through logistic regression analysis.

Results

Overall, 223 (83.8%) pregnant women had scheduled ANC attendance during the lockdown. The predictive factors of ANC attendance were non-relocation (adjusted odds ratio [AOR] = 2.91, 95% confidence interval [CI]: 1.009-8.381) and access to health services (AOR = 2.234, 95% CI: 1.125-4.436).

Conclusion

During the lockdown, ANC attendance slightly declined, and the extended duration of each ANC or reduced face-to-face interactions with healthcare professionals. For pregnant women with non-relocation, healthcare providers must provide opportunities to contact them directly if they had doubts. The limited number of pregnant women who access health services allowed the clinic to be less crowded and therefore easy to ANC attendance.

Genomic epidemiology of SARS-CoV-2 in Cambodia, January 2020 to February 2021

The first case of coronavirus disease 2019 (COVID-19) in Cambodia was confirmed on 27 January 2020 in a traveller from Wuhan. Cambodia subsequently implemented strict travel restrictions, and although intermittent cases were reported during the first year of the COVID-19 pandemic, no apparent widespread community transmission was detected. Investigating the routes of severe acute respiratory coronavirus 2 (SARS-CoV-2) introduction into the country was critical for evaluating the implementation of public health interventions and assessing the effectiveness of social control measures. Genomic sequencing technologies have enabled rapid detection and monitoring of emerging variants of SARS-CoV-2. Here, we detected 478 confirmed COVID-19 cases in Cambodia between 27 January 2020 and 14 February 2021, 81.3 per cent in imported cases. Among them, fifty-four SARS-CoV-2 genomes were sequenced and analysed along with representative global lineages. Despite the low number of confirmed cases, we found a high diversity of Cambodian viruses that belonged to at least seventeen distinct PANGO lineages. Phylogenetic inference of SARS-CoV-2 revealed that the genetic diversity of Cambodian viruses resulted from multiple independent introductions from diverse regions, predominantly, Eastern Asia, Europe, and Southeast Asia. Most cases were quickly isolated, limiting community spread, although there was an A.23.1 variant cluster in Phnom Penh in November 2020 that resulted in a small-scale local transmission. The overall low incidence of COVID-19 infections suggests that Cambodia's early containment strategies, including travel restrictions, aggressive testing and strict quarantine measures, were effective in preventing large community outbreaks of COVID-19.

"Like a wake-up call for humankind": Views, challenges, and coping strategies related to public health measures during the first COVID-19 lockdown in Thailand

Following the first Thai COVID-19 case in January 2020, the Thai government introduced several non-pharmaceutical interventions (NPIs) in March 2020 (e.g., contact tracing, travel restrictions, closure of businesses, curfews, stay at home orders) to control COVID-19 transmissions. This study aimed to understand the views and experiences of a small number of Thai residents related to public health measures implemented during the first COVID-19 wave in Thailand. A total of 28 remote in-depth interviews with Thai residents (18-74 years old) were conducted between 8 May and 21 July 2020. Interviews were audio recorded, transcribed, and analysed using thematic analysis based on the Framework Method. Our results describe participants' views, challenges, and coping strategies relating to COVID-19 restrictions. Most participants expressed support for the introduction of strict public health measures, while some criticized lacking enforcement or rational of certain measures. Participants identified four major challenges, namely financial hardship; social isolation and loneliness; stigma and shaming; and fear of COVID-19 infection. Strategies adopted to address these challenges included practical coping strategies (e.g., reducing risks and fear of COVID-19 infection; mitigating financial, social, and mental health impacts), and embedded socio-cultural ways of coping (e.g., turning to religion; practicing acceptance; kindness, generosity and sharing ('Namjai'); 'making merit' ('Tham-bun')). The challenges identified from this study, in particular the role of stigma and discrimination, may be relevant to other infectious disease outbreaks beyond COVID-19. Findings from this study underscore the need for policies and interventions that mitigate the negative impacts of NPIs on the public, particularly on vulnerable groups, and highlight the importance of considering socio-cultural context to support community resilience in times of crisis. Our findings remain relevant in light of low COVID-19 vaccine availability and the potential need to implement further public health restrictions in Thailand and elsewhere against COVID-19 or future infectious disease threats.

Knowledge, Attitudes, and Practices Regarding “New Normal” Guidelines and Quality of Life Among Thai People During the COVID-19 Outbreak: An Online Cross-Sectional Survey

In Thailand, strict prevention and control strategies have been implemented to mitigate the rapid spread of coronavirus disease 2019 (COVID-19). “New normal” guidelines and a series of mobile health applications have been introduced by the healthcare sector and implemented to aid the disease control monitoring and prevention of widespread outbreaks. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding “new normal” guidelines and quality of life (QOL) among Thai people during the COVID-19 outbreak, and to determine the association between KA, QOL, and practices. An online cross-sectional survey was conducted from 7 June to 12 September 2021 among Thai people in Public Health Region 6 aged ≥ 18 years old. Of the 506 survey participants, 80.3% were female, and 65.0% were 25–59 years old. The survey revealed that 52.2% of participants were classified as having more accurate knowledge, 58.9% were classified as having more positive attitudes, and 80.8% were classified as having more frequent practices regarding “new normal” guidelines, and 54.7% had high QOL. Of the participants, 93.7% agreed that “people who have been fully vaccinated should wear a mask while outside,” and 95.5% wore a face mask outdoors in crowded places. However, 60.9% of participants misunderstood some details regarding online applications for contact tracing and vaccination services, 44.2% felt that these applications were difficult to use, and 33.4% rarely or never downloaded or used these applications. In logistic regression analyses, accurate knowledge of COVID-19 was associated with higher education, being a government employee, monthly family income > 30,000 Thai Baht, and regular use of social media. More positive attitudes regarding “new normal” guidelines and high QOL were associated with positive practices. High QOL was associated with older age, and higher education. Enhancement of attitudes and QOL is also important for improving practices in the general population during the COVID-19 pandemic. Significant factors identified in KAP will be crucial for developing effective prevention and control programs to mitigate the spread of COVID-19. To implement mobile health applications effectively, more work is required to improve the ease of use and promotion strategies.

Utilization of Random Forest Classifier and Artificial Neural Network for Predicting Factors Influencing the Perceived Usability of COVID-19 Contact Tracing “MorChana” in Thailand

With the constant mutation of COVID-19 variants, the need to reduce the spread should be explored. MorChana is a mobile application utilized in Thailand to help mitigate the spread of the virus. This study aimed to explore factors affecting the actual use (AU) of the application through the use of machine learning algorithms (MLA) such as Random Forest Classifier (RFC) and Artificial Neural Network (ANN). An integrated Protection Motivation Theory (PMT) and the Unified Theory of Acceptance and Use of Technology (UTAUT) were considered. Using convenience sampling, a total of 907 valid responses from those who answered the online survey were voluntarily gathered. With 93.00% and 98.12% accuracy from RFC and ANN, it was seen that hedonic motivation and facilitating conditions were seen to be factors affecting very high AU; while habit and understanding led to high AU. It was seen that when people understand the impact and causes of the COVID-19 pandemic’s aftermath, its severity, and also see a way to reduce it, it would lead to the actual usage of a system. The findings of this study could be used by developers, the government, and stakeholders to capitalize on using the health-related applications with the intention of increasing actual usage. The framework and methodology used presented a way to evaluate health-related technologies. Moreover, the developing trends of using MLA for evaluating human behavior-related studies were further justified in this study. It is suggested that MLA could be utilized to assess factors affecting human behavior and technology used worldwide.

Universal access to comprehensive COVID-19 services for everyone in Thailand

Despite Thailand having had universal health coverage (UHC) with comprehensive benefit packages since 2002, services are neither listed nor budget earmarked for COVID-19 responses. Policy decisions were made immediately after the first outbreak in 2020 to fully fund a comprehensive benefit package for COVID-19. The Cabinet approved significant additional budget to respond to the unfolding pandemic. The comprehensive benefit package includes laboratory tests, contact tracing, active case findings, 14-day quarantine measures (including tests, food and lodging), field hospitals, ambulance services for referral, clinical services both at hospitals and in home and community isolation, vaccines and vaccination cost, all without copayment by users. No-fault compensation for adverse events or deaths following vaccination is also provided. Services were purchased from qualified public and private providers using the same rate, terms and conditions. The benefit package applies to everyone living in Thailand including Thai citizens and migrant workers. A standardised and comprehensive COVID-19 benefit package for Thai and non-Thai population without copayment facilitates universal and equitable access to care irrespective of capacity to pay and social status and nationality, all while aiming to supporting pandemic containment. Making essential services available, notably laboratory tests, through the engagement of qualified both public and private sectors boost supply side capacity. These policies and implementations in this paper are useful lessons for other low-income and middle-income countries on how UHC reinforces pandemic containment.

Knowledge, perceived threats and protective behaviour related to COVID 19 among pregnant women

Pregnancy is usually a period of joy, happiness, and expectation for a baby. However, COVID-19 changed the priority and created an environment of worry, perceived threats, and increased protective behaviour to safeguard mother and baby against COVID-19.

METHOD

A cross-sectional study was conducted to assess, the level of knowledge, perceived threats, protective behavior, and factors affecting protective behavior among pregnant women by using a convenient sampling technique. The questionnaire collected the demographic profile, knowledge related to the risk factors of COVID-19, perceived treats (severity and susceptibility), and protective behaviors adopted by pregnant women.

RESULT

Among the 325 pregnant women, knowledge was high (50.5%), the highest relative Importance Index for perceived susceptibility and severity was coming to hospital visits (0.64), and the belief that COVID-19 is a severe health problem (0.81) respectively. Around 69.8% had followed COVID appropriate protective behaviors. The study also revealed that, a high level of knowledge (AOR=2.45, 95%CI:1.45-4.13) and having a university education (AOR= 2.91, 95%CI:1.62-5.22) had a significantly higher probability of adapting COVID appropriate behavior among pregnant women.

CONCLUSION

This study emphasizes the need to streamline communication and adequate education for pregnant women which can help reduce perceived threats and improve protective behavior.

Utilization of Random Forest and Deep Learning Neural Network for Predicting Factors Affecting Perceived Usability of a COVID-19 Contact Tracing Mobile Application in Thailand "ThaiChana"

The continuous rise of the COVID-19 Omicron cases despite the vaccination program available has been progressing worldwide. To mitigate the COVID-19 contraction, different contact tracing applications have been utilized such as Thai Chana from Thailand. This study aimed to predict factors affecting the perceived usability of Thai Chana by integrating the Protection Motivation Theory and Technology Acceptance Theory considering the System Usability Scale, utilizing deep learning neural network and random forest classifier. A total of 800 respondents were collected through convenience sampling to measure different factors such as understanding COVID-19, perceived severity, perceived vulnerability, perceived ease of use, perceived usefulness, attitude towards using, intention to use, actual system use, and perceived usability. In total, 97.32% of the deep learning neural network showed that understanding COVID-19 presented the most significant factor affecting perceived usability. In addition, random forest classifier produced a 92% accuracy with a 0.00 standard deviation indicating that understanding COVID-19 and perceived vulnerability led to a very high perceived usability while perceived severity and perceived ease of use also led to a high perceived usability. The findings of this study could be considered by the government to promote the usage of contact tracing applications even in other countries. Finally, deep learning neural network and random forest classifier as machine learning algorithms may be utilized for predicting factors affecting human behavior in technology or system acceptance worldwide.

Factors Influencing the Perceived Effectiveness of COVID-19 Risk Assessment Mobile Application "MorChana" in Thailand: UTAUT2 Approach

COVID-19 contact-tracing mobile applications have been some of the most important tools during the COVID-19 pandemic. One preventive measure that has been incorporated to help reduce the virus spread is the strict implementation of utilizing a COVID-19 tracing application, such as the MorChana mobile application of Thailand. This study aimed to evaluate the factors affecting the actual usage of the MorChana mobile application. Through the integration of Protection Motivation Theory (PMT) and Unified Theory of Acceptance and Use of Technology (UTAUT2), latent variables such as performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), hedonic motivation (HM), habit (HB), perceived risk (PCR), self-efficacy (SEF), privacy (PR), trust (TR), and understanding COVID-19 (U) were considered to measure the intention to use MorChana (IU) and the actual usage (AU) of the mobile application. This study considered 907 anonymous participants who voluntarily answered an online self-administered survey collected via convenience sampling. The results show that IU presented the highest significant effect on AU, followed by HB, HM, PR, FC, U, SEF, PE, EE, TR, and SI. This is evident due to the strict implementation of using mobile applications upon entering any area of the vicinity. Moreover, PCR was not seen to be a significant latent factor affecting AU. This study is the first to have evaluated mobile contact tracing in Thailand. The integrated framework can be applied and extended to determine factors affecting COVID-19 tracing applications in other countries. Moreover, the findings of this study could be applied to other health-related mobile applications worldwide.

Factors Affecting the Perceived Usability of the COVID-19 Contact-Tracing Application "Thai Chana" during the Early COVID-19 Omicron Period

Thai Chana is one of the mobile applications for COVID-19 disease-control tracking, especially among the Thais. The purpose of this study was to determine factors affecting the perceived usability of Thai Chana by integrating protection motivation theory, the extended technology acceptance model, and the system usability scale. In all, 800 Thais participated and filled an online questionnaire with 56 questions during the early COVID-19 omicron period (15 December 2021 to 14 January 2022). Structural equation modeling (SEM) showed that the understanding of COVID-19 has significant effects on perceived severity and perceived vulnerability, which subsequently leads to perceived usefulness. In addition, perceived usefulness and perceived ease of use have significant direct effects on attitude, which subsequently leads to the intention to use, actual use, and perceived usability. This study is one of the first studies that have analyzed the mobile application for COVID-19 disease-control tracking. The significant and substantial findings can be used for a theoretical foundation, particularly in designing a new mobile application for disease-control tracking worldwide. Finally, protection motivation theory, the extended technology acceptance model, and the system usability scale can be used for evaluating other disease-control tracking mobile applications worldwide.

The performance of COVID-19 Surveillance System as timely containment strategy in Western Oromia, Ethiopia

BACKGROUND

COVID-19 has been swiftly spreading throughout the world ever since it emerged in Wuhan, China, in late December 2019. Case detection and contact identification remain the key surveillance objectives for effective containment of the pandemic. This study was aimed at assessing performance of surveillance in early containment of COVID 19 in Western Oromia, Ethiopia.

METHODS

A cross-sectional study was conducted from August 1 to September 30, 2020, in the 7 kebeles of Nekemte and 2 kebeles of Shambu Town. Residents who lived there for at least the past six months were considered eligible for this study. Data were collected from community and health system at different levels using semi structured questionnaire and checklist, respectively. Participants' health facility usage (dependent variable) and perceived risk, awareness, Socioeconomic Status, and practices (independent variable) were assessed. Bivariable analysis was computed to test the presence of an association between dependent and independent variables. Independent predictors were identified on multivariable logistic regression using a p-value of (<0.05) significance level. We have checked the model goodness of fit test by Hosmer-lemeshow test.

RESULTS

One hundred seventy-nine (41%) of the participants believe that they have a high risk of contracting COVID-19 and 127 (29%) of them reported they have been visited by health extension worker. One hundred ninety-seven (45.2%) reported that they were not using health facilities for routine services during this pandemic. Except one hospital, all health facilities (92%) were using updated case definition. Three (33%) of the assessed health posts didn't have community volunteers. On multivariable logistic regression analysis, the source of income AOR=0.30, 95% CI (0.11, 0.86), perceived level of risk AOR=3.42, 95% CI (2.04, 5.7) and not visited by health extension workers AOR=0.46, 95% CI (0.29, 0.74) were found to be independent predictors of not using health facilities during this pandemic.

CONCLUSION

Event based surveillance, both at community and health facility level, was not performing optimally in identifying potential suspects. Therefore, for effective early containment of epidemic, it is critical to strengthen event based surveillance and make use of surveillance data for tailored intervention in settings where mass testing is not feasible.

Scrutiny of COVID-19 response strategies among severely affected European nations

Although the health care systems in Europe are considered the global benchmark, European nations were severely affected by the coronavirus disease 2019 (COVID-19) pandemic. This manuscript aimed to examine the strategies implemented to combat the COVID-19 pandemic by France, the United Kingdom, Spain, Italy, Germany, and Russia and their outcomes in terms of the number of cases, testing, and deaths. This is the first review of its kind that extensively analyzes the preparedness, mitigation, and response strategies against the COVID-19 pandemic adopted by these nations. This paper further suggests a strategic preparedness model for future pandemics. From the analysis, we found that a decentralized approach, prompt decision-making and timely execution, coordination between local health authorities, and public participation in the implementation of strategies could substantially reduce the case fatality rate. Nations with a high percentage of gross domestic product invested in the health sector, as well as more nurses, physicians, hospital beds, intensive care unit beds, and ventilators, better managed the pandemic. Instead, nations that postponed their pandemic response by delaying tracking, tracing, testing, quarantine, and lockdown were badly affected. The lessons learned from the present pandemic could be used as a guide to prepare for further pandemics.

Responding to the COVID-19 second wave in Thailand by diversifying and adapting lessons from the first wave

Thailand’s first wave of COVID-19 in March 2020 was triggered from boxing events and nightclubs in Bangkok, which spread to 68 provinces. The nation responded rapidly with strong public health and social measures on 26 March 2020. Contact tracing was performed by over 1000 surveillance and rapid response teams with support from 1.1 million village health volunteers to identify, isolate and quarantine cases.

Thailand implemented social measures in April 2020 including a full-scale national lockdown, curfews and 14-day mandatory quarantine for international travellers. With a strong health system infrastructure, people’s adherence to social measures and a whole-of-government approach, the first wave recorded only 3042 cases and 57 deaths with 1.46% case fatality rate. Economic activities were resumed on 1 May 2020 until the end of the year. On 17 December 2020, a second wave was carried by undocumented migrants who were not captured by the quarantine system. As the total lockdown earlier led to serious negative economic impact, the government employed a targeted strategy, locking down specific areas and employing active case finding. Essential resources including case finding teams, clinicians and medicine were mobilised.

With synergistic multisectoral efforts involving health, non-health and private sector, the outbreak was contained in February 2021. Total cases were seven times higher than the first wave, however, early admission and treatment resulted in 0.11% case fatality rate. In conclusion, experiences of responding to the first wave informed the second wave response with targeted locking down of affected localities and active case findings in affected sites.

Building a resilient public health system for international migrant workers: a case study and policy brief for COVID-19 and beyond

Purpose

This article analyzes deficiencies in public health services for international migrant workers (IMWs) during the COVID-19 pandemic and provides a policy brief for improvement of the public health system.

Design/methodology/approach

A COVID-19 outbreak that initially clustered in IMWs and further contributed to the resurgence of the disease across Thailand in December 2020 was analyzed to address the deficiencies in public health services based on the framework of the 10 Essential Public Health Services (EPHS). The EPHS framework was also applied to develop policy options and recommendations in the subsequent policy brief.

Findings

This outbreak unveiled unique challenges that make IMWs more vulnerable to COVID-19. The public health system, challenged by the COVID-19 outbreak among IMWs, manifested deficiencies in the planning and implementation of all essential services. Delayed detection of the outbreak along with the lack of policy accommodating undocumented IMWs and the lack of equitable access to testing and treatment for COVID-19 resulted in the transmission of the disease that harmed the public at large.

Originality/value

The comprehensive analysis of the deficiencies in public health services for IMWs enabled a clear description of problems that could be further prioritized by relevant stakeholders. The policy brief provides policymakers with evidence-based recommendations for improving public health services for IMWs during the COVID-19 pandemic and beyond.

Determinants of Willingness for COVID-19 Vaccine: Implications for Enhancing the Proportion of Vaccination Among Indians

Objective

To assess willingness for the coronavirus disease 2019 (COVID-19) vaccine and identify the factors attributing to the willingness.

Design

A cross-sectional study was conducted, adopting an exponential, non-discriminative snowball sampling technique. The questionnaire collected the socio-demographic profile, history of COVID-19 infection, presence of co-morbidities (diabetes mellitus, hypertension, chronic obstructive pulmonary disease (COPD), asthma, cancer), willingness, and preference of vaccine among participants. An online platform (Google Forms) was used to collect data from all over India. A total of 2032 Indian adults aged above 18 years were included in the study.

Results

Around 1598 (78.6%) expressed willingness to receive the COVID vaccine, and among the healthcare providers (HCPs), 579 (80.3%) were willing for COVID vaccination. Factors like the belief that the vaccine is necessary (aOR=1.68, 95% CI =1.34 to 2.11), respondents having no history of COVID infection (aOR=0.71, 95% CI: 0.52 to 0.97), having trust in the government (aOR=6.09, CI: 4.59 to 7.98), people who felt the cost of the vaccine didn’t matter (aOR=4.92, CI: 3.80 to 6.37), and respondents with no perceived risk of COVID infection (aOR=0.63; CI: 0.47 to 0.83) were more associated with willingness for COVID vaccination.

Conclusions

An effective vaccine should be well-received by the public. The responsibility lies with the government, health authorities, and manufacturers to take appropriate steps to dispel rumors in order to ensure people’s understanding and acceptance.