Determinants of COVID-19 Vaccine Acceptance in Six Lower- and Middle-Income Countries

Abstract Background: While a vaccine is the only clinical preventive measure to control the infection and mortality caused by SARS-CoV-2 (COVID-19), delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal, but there is a lack of evidence around COVID-19 vaccine refusal and delay from a behavioural perspective. This study aims to identify the behavioural determinants of COVID-19 vaccine acceptance and provide recommendations to design actionable interventions to increase the uptake of the COVID-19 vaccine in six lower-and-middle income countries. Methods: Taking into consideration the Health Belief Model (HBM), Theory of Reasoned Action (TRA), and other behavioural models, a Barrier Analysis (BA) approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of Congo, and Tanzania. In all six countries, at least 45 interviews with those who intended to take the vaccine (“Acceptors”) and another 45 or more interviews with those who did not (“Non-Acceptors”) were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (a p-value of less than 0.05) differences between Acceptors and Non-acceptors and to identify which beliefs were most highly associated with acceptance and non-acceptance of the behaviour based on estimated relative risk (ERR). Results: The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk of getting COVID-19, perceived severity of COVID-19, trust in COVID-19 vaccines, perceived safety of COVID-19 vaccines, and expected access to COVID-19 vaccines had the highest association with COVID-19 vaccine acceptance in Bangladesh, Kenya, Tanzania, and DRC. Additional behavioural determinants found to be significant in both Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. The study also identified important perceptions and beliefs around COVID-19 and its severity, advantages and disadvantages of being vaccinated, and action efficacy of the vaccine to control the spread of the virus. Conclusion: Many of the determinants found to be significant and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study in order to significantly increase the uptake of COVID-19 vaccine across these countries.

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Determinants of COVID-19 Vaccine Acceptance in Six Lower- and Middle-Income Countries

10.21203/rs.3.rs-444605/v1 ◽

2021 ◽

Author(s):

Adugna Kebede ◽

Robert Kanwagi ◽

Asrat Tolossa Dibaba ◽

Md Abul Kalam ◽

Thomas Davis ◽

...

Keyword(s):

Perceived Risk ◽

P Value ◽

Negative Consequences ◽

Vaccine Acceptance ◽

Middle Income ◽

Perceived Safety ◽

Middle Income Countries ◽

Advantages And Disadvantages ◽

Vaccine Refusal ◽

Behavioural Determinants

Abstract Background: While a vaccine is the only clinical preventive measure to control the infection and mortality caused by SARS-CoV-2 (COVID-19), delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal, but there is a lack of evidence around COVID-19 vaccine refusal and delay from a behavioural perspective. This study aims to identify the behavioural determinants of COVID-19 vaccine acceptance and provide recommendations to design actionable interventions to increase the uptake of the COVID-19 vaccine in six lower-and-middle income countries.Methods: Taking into consideration the Health Belief Model (HBM), Theory of Reasoned Action (TRA), and other behavioural models, a Barrier Analysis (BA) approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of Congo, and Tanzania. In all six countries, at least 45 interviews with those who intended to take the vaccine (“Acceptors”) and another 45 or more interviews with those who did not (“Non-Acceptors”) were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (a p-value of less than 0.05) differences between Acceptors and Non-acceptors and to identify which beliefs were most highly associated with acceptance and non-acceptance of the behaviour based on estimated relative risk (ERR). Results: The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk of getting COVID-19, perceived severity of COVID-19, trust in COVID-19 vaccines, perceived safety of COVID-19 vaccines, and expected access to COVID-19 vaccines had the highest association with COVID-19 vaccine acceptance in Bangladesh, Kenya, Tanzania, and DRC. Additional behavioural determinants found to be significant in both Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. The study also identified important perceptions and beliefs around COVID-19 and its severity, advantages and disadvantages of being vaccinated, and action efficacy of the vaccine to control the spread of the virus.Conclusion: Many of the determinants found to be significant and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study in order to significantly increase the uptake of COVID-19 vaccine across these countries.

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Determinants of COVID-19 Vaccine Acceptance in Six Lower- and Middle-Income Countries

10.21203/rs.3.rs-444605/v2 ◽

2021 ◽

Author(s):

Adugna Kebede ◽

Robert Kanwagi ◽

Asrat Dibaba Tolossa ◽

Md Abul Kalam ◽

Thomas Davis ◽

...

Keyword(s):

Perceived Risk ◽

P Value ◽

Negative Consequences ◽

Vaccine Acceptance ◽

Middle Income ◽

Perceived Safety ◽

Middle Income Countries ◽

Advantages And Disadvantages ◽

Vaccine Refusal ◽

Behavioural Determinants

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Exploring the behavioral determinants of COVID-19 vaccine acceptance among an urban population in Bangladesh: Implications for behavior change interventions

PLoS ONE ◽

10.1371/journal.pone.0256496 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256496

Author(s):

Md. Abul Kalam ◽

Thomas P. Davis ◽

Shahanaj Shano ◽

Md. Nasir Uddin ◽

Md. Ariful Islam ◽

...

Keyword(s):

Behavior Change ◽

Social Norms ◽

Perceived Risk ◽

Vaccine Hesitancy ◽

Negative Consequences ◽

Vaccine Acceptance ◽

Perceived Safety ◽

Behavioral Determinants ◽

Behavior Change Interventions ◽

The Impact

Background While vaccines ensure individual protection against COVID-19 infection, delay in receipt or refusal of vaccines will have both individual and community impacts. The behavioral factors of vaccine hesitancy or refusal are a crucial dimension that need to be understood in order to design appropriate interventions. The aim of this study was to explore the behavioral determinants of COVID-19 vaccine acceptance and to provide recommendations to increase the acceptance and uptake of COVID-19 vaccines in Bangladesh. Methods We employed a Barrier Analysis (BA) approach to examine twelve potential behavioral determinants (drawn from the Health Belief Model [HBM] and Theory of Reasoned Action [TRA]) of intended vaccine acceptance. We conducted 45 interviews with those who intended to take the vaccine (Acceptors) and another 45 interviews with those who did not have that intention (Non-acceptors). We performed data analysis to find statistically significant differences and to identify which beliefs were most highly associated with acceptance and non-acceptance with COVID-19 vaccines. Results The behavioral determinants associated with COVID-19 vaccine acceptance in Dhaka included perceived social norms, perceived safety of COVID-19 vaccines and trust in them, perceived risk/susceptibility, perceived self-efficacy, perceived positive and negative consequences, perceived action efficacy, perceived severity of COVID-19, access, and perceived divine will. In line with the HBM, beliefs about the disease itself were highly predictive of vaccine acceptance, and some of the strongest statistically-significant (p<0.001) predictors of vaccine acceptance in this population are beliefs around both injunctive and descriptive social norms. Specifically, Acceptors were 3.2 times more likely to say they would be very likely to get a COVID-19 vaccine if a doctor or nurse recommended it, twice as likely to say that most people they know will get a vaccine, and 1.3 times more likely to say that most close family and friends will get a vaccine. The perceived safety of vaccines was found to be important since Non-acceptors were 1.8 times more likely to say that COVID-19 vaccines are “not safe at all”. Beliefs about one’s risk of getting COVID-19 disease and the severity of it were predictive of being a vaccine acceptor: Acceptors were 1.4 times more likely to say that it was very likely that someone in their household would get COVID-19, 1.3 times more likely to say that they were very concerned about getting COVID-19, and 1.3 times more likely to say that it would be very serious if someone in their household contracted COVID-19. Other responses of Acceptors on what makes immunization easier may be helpful in programming to boost acceptance, such as providing vaccination through government health facilities, schools, and kiosks, and having vaccinators maintain proper COVID-19 health and safety protocols. Conclusion An effective behavior change strategy for COVID-19 vaccines uptake will need to address multiple beliefs and behavioral determinants, reducing barriers and leveraging enablers identified in this study. National plans for promoting COVID-19 vaccination should address the barriers, enablers, and behavioral determinants found in this study in order to maximize the impact on COVID-19 vaccination acceptance.

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Association between household air pollution and child mortality in Myanmar using a multilevel mixed-effects Poisson regression with robust variance

Scientific Reports ◽

10.1038/s41598-021-92193-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Juwel Rana ◽

Rakibul M. Islam ◽

Md Nuruzzaman Khan ◽

Razia Aliani ◽

Youssef Oulhote

Keyword(s):

Air Pollution ◽

Child Mortality ◽

Survey Design ◽

Household Air Pollution ◽

P Value ◽

Middle Income ◽

Under Five ◽

Middle Income Countries ◽

Relative Risks ◽

Clean Cookstoves

AbstractHousehold air pollution (HAP) from solid fuel use (SFU) for cooking is a major public health threat for women and children in low and middle-income countries. This study investigated the associations between HAP and neonatal, infant, and under-five child mortality in Myanmar. The study consisted of 3249 sample of under-five children in the households from the first Myanmar Demographic and Health Survey 2016. Fuel types and levels of exposure to SFU (no, moderate and high) were proxies for HAP. We estimated covariate-adjusted relative risks (aRR) of neonatal, infant, and under-five child mortality with 95% confidence intervals, accounting for the survey design. The prevalence of SFU was 79.0%. The neonatal, infant, and under-five child mortality rates were 26, 45, and 49 per 1000 live births, respectively. The risks of infant (aRR 2.02; 95% CI 1.01–4.05; p-value = 0.048) and under-five mortality (aRR 2.16; 95% CI 1.07–4.36; p-value = 0.031), but not neonatal mortality, were higher among children from households with SFU compared to children from households using clean fuel. Likewise, children highly exposed to HAP had higher risks of mortality than unexposed children. HAP increases the risks of infant and under-five child mortality in Myanmar, which could be reduced by increasing access to clean cookstoves and fuels.

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COST, CONTEXT, AND DECISIONS IN HEALTH ECONOMICS AND HEALTH TECHNOLOGY ASSESSMENT

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318000612 ◽

2018 ◽

Vol 34 (5) ◽

pp. 434-441 ◽

Cited By ~ 8

Author(s):

Anthony J. Culyer

Keyword(s):

Health Economics ◽

Health Technology Assessment ◽

Decision Maker ◽

Technology Assessment ◽

Health Technology ◽

Decision Makers ◽

Negative Consequences ◽

Middle Income ◽

Middle Income Countries ◽

Context Dependent

Objectives:This study is an attempt to demystify and clarify the idea of cost in health economics and health technology assessment (HTA).Methods:Its method draws on standard concepts in economics. Cost is a more elusive concept than is commonly thought and can be particularly elusive in multidisciplinary territory like HTA.Results:The article explains that cost is more completely defined as opportunity cost, why cost is necessarily associated with a decision, and that it will always vary according to the context of that decision: whether choice is about inputs or outputs, what the alternatives are, the timing of the consequences of the decision, the nature of the commitment to which a decision maker is committed, who the decision maker is, and the constraints and discretion limiting or liberating the decision maker. Distinctions between short and long runs and between fixed and variable inputs are matters of choice, not technology, and are similarly context-dependent. Harms or negative consequences are, in general, not costs. Whether so-called “clinically unrelated” future costs and benefits should be counted in current decisions again depends on context.Conclusions:The costs of entire health programs are context-dependent, relating to planned rates of activity, volumes, and timings. The implications for the methods of HTA are different in the contexts of low- and middle-income countries compared with high-income countries, and further differ contextually according to the budget constraints (fixed or variable) facing decision makers.

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EXPLORING COVID-19 VACCINE ACCEPTANCE AND HESITANCY DETERMINANTS

Pakistan Journal of Social Research ◽

10.52567/pjsr.v3i01.189 ◽

2021 ◽

Vol 03 (01) ◽

pp. 80-91

Author(s):

Tauheed Zahra ◽

◽

Farhan Ahmad Faiz ◽

Farrah Ahmed ◽

◽

...

Keyword(s):

Educational Background ◽

Vital Role ◽

World Health ◽

Vaccine Hesitancy ◽

Social Worlds ◽

Vaccine Acceptance ◽

Middle Income ◽

Middle Income Countries ◽

Low Middle Income Countries ◽

Health Organization

The World Health Organization recognizes vaccine related myths and conspiracies as the world's top threat to public health safety, particularly in low middle-income countries. The current study aims to explore the beliefs of the general public towards the vaccine acceptance and the hesitancy. The study explicates the COVID 19 vaccine acceptance and hesitancy determinants through an in-depth qualitative approach. A total of 30 male and female millennials from different education backgrounds were interviewed through an interview guide. This study reveals that people have different beliefs related to the vaccine authenticity which plays a vital role in the reluctance towards it. Findings from paper is similar to literature that people from good educational background have similar thoughts towards COVID 19 vaccination. Disregard for the vaccine was caused by various factors, such as misinformation, safety concerns, and personal knowledge. This level of distrust was associated with the social worlds that participants experienced during the pandemic. COVID-19 vaccine hesitancy is a complex relationship that involves the spread of misinformation. Vaccine programs should provide a focused, localized, and empathetic response to counter misinformation. Keywords: COVID-19, vaccines, myths, hesitancy, vaccines awareness, pandemic, conspiracy, corona virus

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Predictors of mortality in children with acute kidney injury in intensive care unit

Paediatrica Indonesiana ◽

10.14238/pi59.2.2019.92-7 ◽

2019 ◽

Vol 59 (2) ◽

pp. 92-7

Author(s):

Umi Rakhmawati ◽

Indah K. Murni ◽

Desy Rusmawatiningtyas

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Protective Factor ◽

Kidney Injury ◽

Pediatric Intensive Care ◽

P Value ◽

Middle Income ◽

Predictors Of Mortality ◽

Middle Income Countries

Background Acute kidney injury (AKI) can increase the morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Previous published studies have mostly been conducted in high-income countries. Evaluations of possible predictors of mortality in children with AKI in low- and middle-income countries have been limited, particularly in Indonesia. Objective To assess possible predictors of mortality in children with AKI in the PICU. Methods We conducted a retrospective cohort study at Dr. Sardjito Hospital, Yogyakarta, Indonesia. All children with AKI admitted to PICU for more than 24 hours from 2010 to 2016 were eligible and consecutively recruited into the study. Logistic regression analysis was used to identify independent predictors. Results Of the 152 children with AKI recruited, 119 died. In order to get a P value of <0.25, multivariate analysis is run to degree AKI, ventilator utilization, primary infection disease, MOF and age.Multivariate analysis showed that ventilator use, severe AKI, and infection were independently associated with mortality in children with AKI, with odds ratios (OR) of 19.2 (95%CI 6.2 to 59.7; P<0.001), 8.6 (95%CI 2.7 to 27.6; P<0.001), and 0.2 (95%CI 0.1 to 0.8; P=0.02), respectively. Conclusion The use of mechanical ventilation and the presence of severe AKI are associated with mortality in children with AKI admitted to the PICU. Interestingly, the presence of infection might be a protective factor from mortality in such patients.

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Association between Acne and Body Mass Index: A Hospital Based Cross Sectional Study

Nepal Journal of Dermatology Venereology & Leprology ◽

10.3126/njdvl.v16i1.19408 ◽

2018 ◽

Vol 16 (1) ◽

pp. 53-56

Author(s):

Saraswoti Neupane ◽

Binamra Basnet ◽

Tara Devi Sharma

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Acne Vulgaris ◽

Cross Sectional Study ◽

Normal Weight ◽

P Value ◽

Cross Sectional ◽

Middle Income ◽

Medical College ◽

Middle Income Countries

Introduction: Acne vulgaris is a common and chronic inflammatory skin disease of pilosebaceous unit. Obesity is one of the biggest problems in western life style but nowadays, the problem is increasing even in low and middle-income countries. Body Mass Index (BMI) is used to accurately measure obesity.Objective: To find out the association between different categories of BMI and severity of acne.Materials and methods: This was a cross sectional prospective study conducted in the outpatient department of Gandaki Medical College from January to July, 2017. All the newly diagnosed patients with acne were included in the study. Height and weight of the patients was recorded and BMI was calculated. BMI was categorized as underweight, normal weight, overweight and obese. Type of lesions were noted and severity of acne was graded from 1 to 4.Statistical analysis was performed using SPSS version 17.0 for windows. One-way Analysis of Variance between groups (ANOVA) test was applied. P value of less than 0.05 was considered significant.Results: There were altogether 249 patients with acne. Age of the patients ranged from 10 to 44 years with mean age of 20.82 ±5.9 years. Most of the patients were in the age group of 11-20 years. Female: male ratio was 1:1.4. Majority of patients (65.5%) had normal BMI. Most of the patients had Grade 2 acne (52.6%). There was no significant association between the BMI and severity of acne (p=0.129).Conclusion: There was no significant association between BMI and severity of acne.

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Non-medical Interventions to Reduce the Burden of Psychosocial and Economic Impacts of COVID-19 Pandemic: A Scope Review

Shiraz E-Medical Journal ◽

10.5812/semj.118177 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Sajjad Azmand ◽

Hassan Joulaei ◽

Maryam Fatemi

Keyword(s):

Economic Status ◽

Target Population ◽

Developed Countries ◽

Vital Role ◽

Vulnerable Groups ◽

Economic Aspects ◽

Negative Consequences ◽

Middle Income ◽

Medical Interventions ◽

Middle Income Countries

Context: COVID-19, like the other pandemics, apart from its impacts on peoples' health, has had diverse huge impacts on psycho-socio-economic aspects of societies globally. Hence, applying appropriate interventions to reduce the indirect burden of this pandemic is as important as patients’ care. Objectives: In this study, we aimed to review the main interventions against the economic and psychosocial impacts of the COVID-19 pandemic. Method: This scope review was conducted to determine what measures have been taken by governments against different non-medical (economic and psychosocial) consequences of the COVID-19 pandemic. The authors reviewed the relevant articles published from December 2019 to December 2020 through three databases of PubMed/MEDLINE, Scopus, and Google Scholar. The interventions in three areas of economic, social, or psychological were exerted, and in the review of the articles, the country and the target population were considered. Finally, the results were categorized and presented descriptively. Results: Regarding the negative consequences of the COVID-19 pandemic in psychosocial and economic aspects of societies, governments, especially in developed countries, have established measures to reduce the burdens of these consequences. Apart from interventions related to the general population, at-risk and vulnerable groups and also those with low socio-economic status are specific target populations for interventions. Conclusions: The future of the COVID-19 pandemic is uncertain and unpredictable. Governments and their decisions will play a vital role in determining the trend of the pandemic. Therefore, it is the responsibility of governments, especially in lower-middle-income countries (LMICs), to support vulnerable people and protect them against the devastating socio-economic and psychological effects of this pandemic using all their capacity.

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Determinants of Clean Birthing Practices in Low- and Middle-Income Countries: a Scoping Review

10.21203/rs.2.16010/v1 ◽

2019 ◽

Author(s):

Joanna Esteves Mills ◽

Erin Flynn ◽

Oliver Cumming ◽

Robert Dreibelbis

Keyword(s):

Healthcare Facility ◽

Perinatal Period ◽

Screening Process ◽

Middle Income ◽

Middle Income Countries ◽

Effective Interventions ◽

Multi Stage ◽

Behavioural Determinants ◽

Birthing Practices ◽

Low And Middle Income

Abstract Background Infection is a leading cause of maternal and newborn mortality in low- and middle-income countries (LMIC). Clean birthing practices are fundamental to infection prevention efforts, but these are inadequate in LMIC. This scoping study reviews the literature on studies that describe determinants of clean birthing practices of healthcare workers or mothers during the perinatal period in LMIC. Methods We reviewed literature published between January 2000 and February 2018 providing information on behaviour change interventions, behaviours or behavioural determinants during the perinatal period in LMIC. Following a multi-stage screening process, we extracted key data manually from studies. We mapped identified determinants according to the COM-B behavioural framework, which posits that behaviour is shaped by three categories of determinants – capability, opportunity and motivation. Results 78 studies were included: 47 observational studies and 31 studies evaluating an intervention. 51% had a household or community focus, 28% had a healthcare facility focus and 21% focused on both. We identified 31 determinants of clean birthing practices. Determinants related to clean birthing practices as a generalised set of behaviours featured in 50 studies; determinants related specifically to one or more of six predefined behaviours – commonly referred to as “the six cleans” – featured in 31 studies. Determinants of hand hygiene (n=13) and clean cord care (n=11) were most commonly reported. Reported determinants across all studies clustered around psychological capability (knowledge) and physical opportunity (access to resources). However, greater heterogeneity in reported behavioural determinants was found across studies investigating specific clean birthing practices compared to those studying clean birthing as a generalised set of behaviours. Conclusions Efforts to combine clean birthing practices into a single suite of behaviours – such as the “six cleans”– may simplify policy and advocacy efforts. However, each clean practice has a unique set of determinants and understanding what drives or hinders the adoption of these individual practices is critical to designing more effective interventions to improve hygiene behaviours and neonatal and maternal health outcomes in LMIC. Current understanding in this regard remains limited. More theory-grounded formative research is required to understand motivators and social influences across different contexts.

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