COVID-19 vaccine brand hesitancy and other challenges to vaccination in the Philippines

Effective and safe COVID-19 vaccines have been developed at a rapid and unprecedented pace to control the spread of the virus, and prevent hospitalisations and deaths. However, COVID-19 vaccine uptake is challenged by vaccine hesitancy and anti-vaccination sentiments, a global shortage of vaccine supply, and inequitable vaccine distribution especially among low- and middle-income countries including the Philippines. In this paper, we explored vaccination narratives and challenges experienced and observed by Filipinos during the early vaccination period. We interviewed 35 individuals from a subsample of 1,599 survey respondents 18 years and older in the Philippines. The interviews were conducted in Filipino, Cebuano, and/or English via online platforms such as Zoom or via phone call. All interviews were recorded, transcribed verbatim, translated, and analysed using inductive content analysis. To highlight the complex reasons for delaying and/or refusing COVID-19 vaccines, we embedded our findings within the social ecological model. Our analysis showed that individual perceptions play a major role in the decision to vaccinate. Such perceptions are shaped by exposure to (mis)information amplified by the media, the community, and the health system. Social networks may either positively or negatively impact vaccination uptake, depending on their views on vaccines. Political issues contribute to vaccine brand hesitancy, resulting in vaccination delays and refusals. Perceptions about the inefficiency and inflexibility of the system also create additional barriers to the vaccine rollout in the country, especially among vulnerable and marginalised groups. Recognising and addressing concerns at all levels are needed to improve COVID-19 vaccination uptake and reach. Strengthening health literacy is a critical tool to combat misinformation that undermines vaccine confidence. Vaccination systems must also consider the needs of marginalised and vulnerable groups to ensure their access to vaccines. In all these efforts to improve vaccine uptake, governments will need to engage with communities to ‘co-create’ solutions.

Effects of COVID-19 Lockdown on Managing Diabetes Mellitus Among Sudanese Insulin Pump Users, A Cross-Sectional Study

Background COVID-19 lockdown has affected diabetes management among the insulin pump users by changing their life style, affected their mental health, limited diabetes and insulin pump supplies and more difficult communication with the healthcare providers Objectives The aim of this research is to study the effects of COVID-19 lockdown on managing diabetes mellitus among Sudanese insulin pump users, Sudan (March- September 2020). Methodology: This is a descriptive cross-sectional community based study which was done in contact with Shimaa medical CO. LTD. 26 insulin pump users were chosen by total coverage and the data was collected throughout phone call interviews. All statistical analyses were performed using IBM SPSS Statistics software, version 20. Results The mean age of 22 participants was 25.3 ± 17.2 years, and the majorities (63.6%) were females. The average duration of diabetes was 6.9 ± 3.9 years, and the average duration of insulin pump use was 3 ± 1 years. Of the 22 patients (90.9%) used glucometer for monitoring blood sugar. 9 (40.9%) were less subjective to depression, 9 (40.9%) had moderate susceptibility to have depression. 8 patients (36.4%) reported weight gain, 12 patients (54.5%) reported no weight changes, while 2 patients (9.1%) reported weight loss. The level of physical activity decreased in 10 patients (45.5%), and the dietary habits remained unchanged in 50%. Moreover, participants who reported a decrease in physical activity levels were more likely to report weight gain (P = 0.004) compared with those who reported an increase in physical activity levels. Most of the patients have unchanged behaviors regarding experiencing hyper and hypoglycemic symptoms 45.5%, 72.7% respectively. Most of the patients have unchanged adherence to the insulin pump behaviors, carb counting (63.6%), bolus wizard during mealtime (68.2%), and bolus wizard for hyperglycemia correction (68.2%), self-monitoring of blood glucose (40.9%). (40.9%) of the patients had scheduled phone call appointments, 5 patients (22.7%) received virtual education (VE) from the insulin pump technician. 12 patients (54.5%) reported difficulty obtaining at least one type of insulin pump supply. Conclusion COVID-19 lock down has led to the decrease in physical activity with unchanged dietary habits. Getting the insulin pump supplies was difficult for most of the patient’s, and there was shortage and increase prices for diabetes care supplies. Telemedicine should be considered seriously to ease the communication between the patients and the health care providers.

Early observations from the HIV self-testing program among key populations and sexual partners of pregnant mothers in Kampala, Uganda: A cross sectional study

Background HIV self-testing (HIVST) was adopted for key populations (KPs) and sexual partners of pregnant and lactating women (mothers) in Uganda in October 2018. We report early observations during HIVST implementation in Kampala, Uganda. Methods HIVST was rolled out to reach those with unknown HIV status at 38 public health facilities, using peer-to-peer community-based distribution for female sex workers (FSW) and men who have sex with men (MSM) and secondary distribution for mothers, who gave HIVST kits to their partners. Self-testers were asked to report results within 2 days; those who did not report received a follow-up phone call from a trained health worker. Those with HIV-positive results were offered confirmatory testing at the facility using the standard HIV-testing algorithm. Data on kits distributed, testing yield, and linkage to care were analysed. Results We distributed 9,378 HIVST kits. Mothers received 5,212 (56%) for their sexual partners while KPs received 4,166 (44%) (MSM, 2192 [53%]; FSW1, 974, [47%]). Of all kits distributed, 252 (3%) individuals had HIV-positive results; 126 (6.5%) FSW, 52 (2.3%) MSM and 74 (1.4%) partners of mothers. Out of 252 individuals who had HIV-positive results, 170 (67%) were confirmed HIV-positive; 36 (2%) were partners of mothers, 99 (58%) were FSW, and 35 (21%) were MSM. Linkage to treatment (126) was 74%. Conclusions HIVST efficiently reached, tested, identified and modestly linked to care HIV positive FSW, MSM, and partners of mothers. However, further barriers to confirmatory testing and linkage to care for HIV-positive self-testers remain unexplored.

Cost-effectiveness analysis of an active 30-day surgical site infection surveillance at a tertiary hospital in Ghana: evidence from HAI-Ghana study

ObjectiveTo assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study.DesignBefore and during intervention study using economic evaluation model to assess the cost-effectiveness of an active 30-day SSI surveillance at a teaching hospital. The intervention involves daily inspection of surgical wound area for 30-day postsurgery with quarterly feedback provided to surgeons. Discharged patients were followed up by phone call on postoperative days 3, 15 and 30 using a recommended surgical wound healing postdischarge questionnaire.SettingKorle-Bu Teaching Hospital (KBTH), Ghana.ParticipantsAll prospective patients who underwent surgical procedures at the general surgical unit of the KBTH.Main outcome measuresThe primary outcome measures were the avoidable SSI morbidity risk and the associated costs from patient and provider perspectives. We also reported three indicators of SSI severity, that is, length of hospital stay (LOS), number of outpatient visits and laboratory tests. The analysis was performed in STATA V.14 and Microsoft Excel.ResultsBefore-intervention SSI risk was 13.9% (62/446) as opposed to during-intervention 8.4% (49/582), equivalent to a risk difference of 5.5% (95% CI 5.3 to 5.9). SSI mortality risk decreased by 33.3% during the intervention while SSI-attributable LOS decreased by 32.6%. Furthermore, the mean SSI-attributable patient direct and indirect medical cost declined by 12.1% during intervention while the hospital costs reduced by 19.1%. The intervention led to an estimated incremental cost-effectiveness ratio of US$4196 savings per SSI episode avoided. At a national scale, this could be equivalent to a US$60 162 248 cost advantage annually.ConclusionThe intervention is a simple, cost-effective, sustainable and adaptable strategy that may interest policymakers and health institutions interested in reducing SSI.

Transforming CRM Through Artificial Intelligence

The present times are disrupting times for every kind of business and every aspect of a business. It is not about contactlessness; it is about seamlessness. The auto manufacturers have already started “Amazoning” dealerships. Brands are developing customer-specific platforms like jaguar.rockar.com, where one can explore the range, check the price, select dealer, search inventory, and schedule test drives. The brand Cadillac creates virtual reality experiences in Google Search, wherein a car appears in a living room through a phone call. One can see how it looks, walk around it, open the doors, and get a sense of the interior. This chapter explores the transformation of CRM through artificial intelligence.

Implementing ACT-Based Modalities for Establishing Connectivity among Teachers and Students in the Context of COVID-19

The government aims to make education accessible to all the people of the country can be fulfilled if the online education system is developed enough for all. The country may be benefited by the use of the right type of education system. Learners and teachers get advantages if the education system is reformed using digital technologies like Automatic Call Tree (ACT)-based modalities. Such types of education system has key significant in the pandemic situation which have been facing since two years. This study is assumed to examine the Automatic Call Tree (ACT) based modalities and their utilization for connection between students, teachers, parents and school management committee; and some recommendations are made concerning online education. The main information source for this study is primary. Instruments used are questionnaires, interview with video recording, phone call, and class room observation. The preliminary finding showed that there is a scarcity of orientations of online education to parents, students, teachers, and administrators, though all were found to realize its importance. Likewise, major problems found are lack of digital devices, regular power supply and backup; and network connectivity. Based on the opinions of the respondents and observations of the situations of the different parts of the country running online education during this pandemic period, many recommendations are made. The country needs strategic plans and policy to make online education accessible to all learners specially in urban areas of Nepal and this will ensure online education smooth. It concludes that the Automatic Call Tree (ACT)-based modalities became fruitful for some schools of Nepal during Corona Virus (COVID)-19 pandemic. But many of them are facing different problems while conducting online classes, examination and result processing. Providing practical knowledge and skills about engineering, mathematics, health science, account, computer science subjects are very difficult and to examine them.

Comparative analysis of an innovative app versus conventional techniques to improve patient compliance after minor oral surgical procedures (Preprint)

BACKGROUND Certain factors such as compliance, comprehension, retention of instructions, and other unaccounted elements impact the objectives of post-operative care. It is imperative that patients follow the instructions and prescribed regimen diligently for a smooth and placid healing. Keeping the same principles in view, ExoDont was designed by our team, an android-based mHealth app which ensures a smooth post-operative period for the patients after a dental extraction. Besides providing post-operative instructions at defined intervals, the app also sends out drug reminders as an added advantage over other available conventional modes. OBJECTIVE To compare the compliance rate of individuals with respect to the prescribed regimen, postoperative instructions, and additionally, assess any significant changes in post-operative complications rate under the three categories namely Verbal, Verbal plus Written, and ExoDont group. METHODS The patients after tooth extraction were randomly assigned to the aforementioned groups and a one week follow-up through a phone call was planned to obtain the responses from study participants. The result obtained from the three groups was then statistically analyzed. RESULTS The compliance rate in patients for post-operative instructions and prescribed drug adherence was statistically significant in the group using ExoDont app than in Verbal or Verbal plus Written group. However, the difference in the incidence of postoperative complication rate was not significant among the three groups. CONCLUSIONS As evident from the result, it is anticipated that the ExoDont app will be revolutionary in not only circumventing the unaccounted possibilities of missing the prescribed dose and post-operative instructions but also ensure a smooth post-operative phase and easy recovery for the patients.

21st Century Good Neighbor Program: An Easily Generalizable Program to Reduce Social Isolation in Older Adults

Aim: In this once-in-a-lifetime humanitarian crisis, what does it mean to be a good neighbor? It means that as a community, we must address loneliness and barriers to care faced by vulnerable populations such as older adults. We share an inexpensive longitudinal experiential service-learning program implemented by health professions and undergraduate student volunteers that aims to help alleviate loneliness in older adults while imparting meaningful experiences to volunteers.Intervention Design and Setting: The 21st Century Good Neighbor Program is an observational cohort study of an experiential service-learning program started in May 2020, and this article shares the results collected after 1 year. This longitudinal, weekly phone call program was conducted in a single community setting in the Midwestern part of the United States. Older adults over the age of 60 served by a local community service agency (CSA) were invited to participate. Volunteers consisted of students 18 or older. Student volunteers made regular phone calls to a pair of older adults throughout the course of 1 year following standardized call scripts. The loneliness of the older adults was measured by volunteers using the 3-item UCLA Loneliness Assessment.Results: 261 older adults were engaged in conversations with a volunteer. A total of 1,391 calls were accepted by older adults and the median length of a welcomed call was 11 min. The average baseline loneliness score was 4.156 ± 1.41 and the prevalence of social isolation was 19.5%. There was no significant change in the UCLA loneliness score in the first year of follow up. However, a majority of volunteers (88%) agreed or strongly agreed that the program had a positive impact on them. In addition, the program identified 257 issues older adults faced that required follow-up. The most prevalent concerns referred to the community service agency by volunteers were issues related to utilities, food and transportation access.Conclusion: The 21st Century Good Neighbor Program is a unique intervention in which student volunteers and older adults paired by a community service agency forge relationships though a longitudinal phone call-based program. This easy-to-implement program provides another layer of support to identify and refer issues that impact social determinants of health. The added benefit of volunteer satisfaction in the setting of COVID 19 pandemic is heartening. We hope to continue to study the impact of this intervention on social isolation in this vulnerable population.

Do mothers pick up a phone? A cross-sectional study on utilizations of MCH voice messages in Lagos, Nigeria (Preprint)

BACKGROUND Voice messages have been employed as the effective and efficient means for increasing health service utilizations and health promotion in low- and middle-income countries. Yet, unlike SMS, voice message services require their users to pick up a phone call at the time of its delivery. Furthermore, voice messages are difficult for the users to review their contents afterwards. While recognizing that voice messages are more friendly to specific groups (eg, illiterate or less literate populations), there should be several challenges in successfully operationalizing its intervention program. OBJECTIVE This study is aimed at estimating the extent to which voice message service users pick up the phone calls of voice messages and complete listening up to or beyond the core part of voice messages. METHODS A voice message service program composed of 14 episodes on maternal, newborn and child health was piloted in Lagos, Nigeria, during the period from 2017 to 2019. A voice message call of each of 14 episodes was delivered to the mobile phones of the program participants, per day for 14 consecutive days. A total of 513 participants in the voice message service chose one of five locally spoken languages as the language to be used for voice messages. Two multilevel logistic regression models were created: (1) Model 1 for testing whether a voice message call is picked up; and (2) Model 2 for testing whether a voice message call having been picked up is listened to up to the core messaging part. RESULTS The greater the voice message episode number became, the smaller proportion of the participants picked up the phone calls of voice message (aOR: 0.98; 95% CI: 0.97-0.99; P=.01). Only 854 of 3765voice message calls having been picked up by the participants (22.7%) were listened to up to their core message parts. It was found that the level of sequentiality between picking up a phone call of a voice message and listening up to the core message part was low. This indicates discontinuity between these two actions. CONCLUSIONS The participants were likely to stop picking up the phone as the episode number of voice messages progressed. In view of discontinuity and independence between picking up a phone call and listening up to the core message part, we should not assume that those picking up the phone would automatically complete listening to the entire or core voice message.

Generalized Confidence Intervals for Zero-Inflated Pareto Distribution

This paper considers interval estimations for the mean of Pareto distribution with excess zeros. Three approaches for interval estimation are proposed based on fiducial generalized pivotal quantities (FGPQs), respectively. Simulation studies are performed to assess the performance of the proposed methods, along with three measurements to determine comparisons with competing approaches. The advantages and disadvantages of each method are provided. The methods are illustrated using a real phone call dataset.