Journal of Public Health in Africa最新文献

Background: Diagnostic tests for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be performed based on symptomatic presentation or for screening of asymptomatic persons. Testing can limit spread by enabling rapid identification of cases leading to containment measures. However, views regarding diagnostic test as a containment intervention vary across different settings.

Aim: To synthesise the findings of qualitative studies on the perceptions and factors influencing the uptake of diagnostic test interventions for SARS-CoV-2.

Setting: Healthcare facilities, care homes, communities including households.

Method: We searched MEDLINE database and the (WHO) SARS-CoV-2 Research database from 01 January 2020 to 06 September 2022. Qualitative data were synthesised thematically while data for barriers and facilitators were synthesised using the SURE framework. The GRADE-CERQual approach was used to assess the confidence in each review finding, while the ENTREQ checklist was used to report the QES. The quality of included studies was assessed with the CASP tool.

Results: Twenty two studies were included for QES. Two were conducted in the health facility setting, 2 in care homes, and 18 in the community. Twenty of the studies came from high-income countries, 2 from low- and middle-income countries. In all, 13 analytical and 31 descriptive themes of low to moderate quality evidence emerged; mainly around fear of contracting COVID-19, test procedure and socio-economic implications of a positive test result.

Conclusion: Low to moderate quality evidence of barriers to uptake of diagnostic test were largely due to misconceptions about the interventions.

Contribution: Sensitising and engaging communities and stakeholders in the healthcare system, will help mitigate the fear barrier and enhance policy coordination.

Diethylene glycol (DEG) and ethylene glycol (EG) are organic compounds often found in various consumer products, including antifreeze and industrial solvents used in pharmaceutical preparations, as well as serving as raw materials for polymer manufacturing. Since September 2022, seven consecutive episodes of DEG and EG contamination have been reported across at least nine countries. A notable commonality among the affected products is that at least 14 of them are fixed-dose combinations (FDCs). However, the evidence supporting the efficacy of most of these combinations is insufficient, which renders their prescription, dispensing, and use irrational. Moreover, these products are not without risk, as they can cause adverse reactions. Several factors contribute to the prevalence of these irrational FDCs, including low production costs, consumer popularity, and a tendency to authorise locally manufactured products. As a result, many countries' pharmaceutical markets keep marketing authorisation for irrational FDCs. The persistent reports of DEG or EG contamination - especially those involving irrational fixed-dose combinations - present a crucial opportunity to enhance quality control measures. In addition, it is imperative to reevaluate the marketing authorisations of these products that lack evidence of safety and efficacy, adapting the national medicines lists and clinical guidelines to WHO recommendations. Strengthening regulatory frameworks and implementing stringent manufacturing and quality assurance standards are essential to prevent contamination incidents and ensure the safety of pharmaceutical products.

Background: Vaccine hesitancy hinders COVID-19 control, especially among healthcare workers (HCWs).

Aim: This study examined factors influencing COVID-19 vaccine uptake and hesitancy among HCWs in Abidjan, Côte d'Ivoire.

Setting: The study was conducted among healthcare workers in Abidjan, the capital city of Côte d'Ivoire.

Methods: A cross-sectional study was conducted from May 2023 to June 2023 in Abidjan. A total of 240 HCWs completed a questionnaire on vaccination attitudes, hesitancy factors and willingness to recommend vaccines. Descriptive statistics and modified Poisson regression estimated adjusted prevalence ratios (aPR) at a 95% confidence interval.

Results: Among participants, 57.5% were female, with a median age of 40 years (IQR: 33-45). HCWs included physicians (26.7%), nurses/midwives (22.5%) and pharmaceutical staff (19.2%). They worked in teaching hospitals (23.3%), general hospitals (30.8%) and community hospitals (45.8%). Vaccine uptake was 73.3%, with 53.3% fully vaccinated and only 4.6% receiving a booster dose. However, 42.1% exhibited vaccine hesitancy, mainly due to concerns about side effects (52.2%). While 55.0% would recommend the vaccine, only 46.3% felt confident addressing patient questions. Age was positively correlated with vaccine uptake: HCWs aged 35-44 years, 45-54 years and 55-65 years were 1.60, 1.68 and 1.78, respectively times more likely to be vaccinated, respectively, compared to those aged 22-34 years.

Conclusion: Vaccine hesitancy (25%) and low booster uptake (4.6%) highlight the need for targeted education and pharmacovigilance. Strengthening HCWs vaccine knowledge and trust is essential for epidemic control.

Contribution: This study underscores the importance of Ministry of Health-led interventions to improve HCWs vaccination rates in Africa.

Background: The Joint United Nations Programme on HIV/AIDS (UNAIDS) set targets for 95% of people living with human immunodeficiency virus (HIV) infection to know their status, 95% to receive antiretroviral therapy (ART) and 95% to achieve viral suppression. These targets mirror the 90-90-90 targets that were aimed to be met by 2020 to end AIDS as a public health threat by 2030.

Aim: The study aims to synthesise evidence on recommendations, best practices and challenges in achieving 90-90-90 escalated to 95-95-95 fast-track targets in sub-Saharan Africa.

Setting: The review included empirical evidence from sub-Saharan Africa.

Method: We followed Arksey and O'Malley's methodological framework for this scoping review. A systematic search of relevant articles was conducted using electronic databases such as Scopus, EBSCOHost, PubMed, Science Direct and Sabinet. The results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Results: There were 6943 relevant study titles that were identified from the five databases. Following duplicates removal, title and abstract screening, 31 articles were included for full-text review. A combination of qualitative, quantitative and mixed methods studies were included.

Conclusion: The 90-90-90 targets have been achieved in part, but challenges remain, particularly for key and vulnerable populations. Even as successes and challenges towards '90-90-90 by 2020' are outlined, new fast-track '95-95-95 by 2030' targets have been established because of concerns that the original targets may not have achieved epidemic control.

Contribution: The findings of this review have implications for policy and practice related to interventions to facilitate the realisation of HIV epidemic control as outlined by the UNAIDS 95-95-95 treatment cascade.

Background: Few would argue that vaccines have not saved more lives than any other medical invention. Eradicating smallpox, reducing wild poliovirus, saving the world from the Ebola virus, and reversing the trend of COVID-19 infections, vaccines are common references in revolutionising global health. These successes were not achieved without varying perceptions of the risks of diseases versus the benefits of vaccination.

Aim: The study aimed to assess whether the perceived severity versus benefits of vaccination significantly influenced COVID-19 vaccination.

Setting: This study was conducted in the Manyara region, Tanzania.

Methods: A cross-sectional study were conducted among adults above 18 years across seven councils of the Manyara region, Tanzania. Forty focus group discussions (FGDs) and 32 key informant interviews (KIIs) generated qualitative data, in contrast to household surveys for quantitative data.

Results: Over half, 54.6%, who perceived the COVID-19 vaccine as effective in preventing severe illness or death were vaccinated compared to those who disagreed (45.1%), indicating a strong association between vaccine effectiveness perception and vaccine acceptance or hesitancy (p = 0.003). Similarly, closeness or personal contact with an infected person was a major determinant for vaccination. Some 62.9% of respondents whose family members or friends were infected were vaccinated compared to 43.8% without any close experience of the infection (p = 0.032).

Conclusion: This study found that perceptions of the severity of risks or benefits of vaccination significantly influenced the uptake of COVID-19 vaccination in Manyara.

Contribution: This study underscores the importance of other factors that influence perceptions of risks and benefits of healthcare services even if they were offered at no cost to the beneficiary.

Background: The influence of religion on health seeking behaviour is well document in the public health literature. However, the extent to which religious discourses and practices contributed to scepticism towards COVID-19 vaccines, vaccine uptake, and indecisiveness in intention to be vaccinated in Tanzania has not yet been established.

Aim: To explore the nexus between religion and public health in the measures taken against the COVID-19 pandemic in Tanzania by empirically examining how religious actors in opposed the first phased of COVID-19 vaccination campaigns before becoming key supporters of the same campaigns in the second phase.

Setting: The study was conducted in eight regions representing key administrative zones of Mainland Tanzania.

Methods: The article draws on empirical evidence from exploratory mixed-method study combining focus group discussions (FGDs), key informant and semi-structured interviews.

Results: We found that religious narratives and practices in relation to the pandemic were quite dynamic but influential in shaping individuals' decisions including on whether or not to take the COVID-19 vaccine. Religious anti-COVID-19 vaccine narratives accounted for the slow COVID-19 vaccine uptake but when religious leaders were later mobilised to support the COVID-19 vaccination campaign, the vaccine uptake in Tanzania improved considerably.

Conclusion: The study concludes that religious actors play a significant role in influencing public health behaviours, particularly in vaccine uptake.

Contribution: Future public health measures designed to increase vaccine uptake should not overlook the salient role of religious actors in the promotion desired health practices and outcomes.

Background: After the outbreak of COVID-19, the World Health Organization (WHO) identified vaccines as one of the intervention mechanisms capable of controlling and preventing COVID-19 infections. However, the uptake of the vaccine was below the expectation, while the cause for such manifestation was unclear.

Aim: This study aimed to examine the attitude of Pentecostal believers towards COVID-19 vaccines in Dar es Salaam, Tanzania. The focus was to investigate the role of religion in COVID-19 vaccinations.

Setting: This study was conducted at three Pentecostal churches, namely Arise and Shine Ministry, Ufufuo na Uzima Ministry and Tanzania Assemblies of God - Makongo-juu, all located in Dar es Salaam, Tanzania.

Methods: The study employed qualitative interviews to generate information from 55 Pentecostal believers.

Results: Findings from this study attest that the attitude of Pentecostal believers towards COVID-19 vaccines was mixed; some hesitated to be vaccinated and another quarter accepted vaccination. Despite being provided free of charge, the uptake of the COVID-19 vaccine was attributed to the social-ecological factors that the individuals were in.

Conclusion: Religion has remained a key factor for hesitancy toward COVID-19 vaccines among believers. The best way to increase acceptance of COVID-19 among believers, is to have an appreciation of the socio-cultural and ecological environment where Individuals' member resources are stored. Acceptance of COVID- 19 was not only related to scientific and medical factors, but rather religious issue as well.

Contribution: It contributes to public health efforts that acknowledges the engagement of religious and socio-cultural dimensions to disease outbreaks and interventions.

Background: The COVID-19 pandemic continues to challenge global public health, with vaccination playing a key role in mitigating transmission. Despite recognising its importance, Tanzania exhibits considerable regional disparities in vaccine uptake. Understanding the determinants influencing vaccination is essential.

Aim: This study investigated determinants of COVID-19 vaccination rates within Tanzania, employing a socio-ecological framework to comprehensively examine individual, interpersonal, community, and institutional influences.

Setting: Eight regions across Tanzania, purposively selected to represent urban, peri-urban, and rural contexts, reflecting varying socio-cultural and infrastructural conditions.

Methods: A concurrent mixed-method design was utilised, combining quantitative surveys from 3098 participants with qualitative data collected through focus group discussions and key informant interviews.

Results: Although general awareness of COVID-19 was notably high (99.3%), overall vaccine acceptance remained low (37.2%), exhibiting significant regional variations (22.5% in Morogoro to 50.0% in Mtwara). Individual factors such as personal vaccine beliefs, perceived safety, and misinformation significantly impacted uptake. Interpersonal influences from family, friends, and community leaders critically shaped vaccination decisions. Despite high acknowledgment of community leaders' roles (88.3%), governmental campaign awareness was minimal (22.4%). Institutional factors, notably healthcare system trust and vaccine accessibility, also significantly influenced uptake.

Conclusion: Findings advocate for region-specific, multilevel interventions addressing misinformation, engaging trusted community influencers, improving transparency, and enhancing healthcare service delivery to mitigate disparities and enhance vaccine acceptance.

Contribution: The study offers insights foundational for tailored public health strategies, improving vaccine accessibility and resilience against future pandemics in Tanzania and comparable socio-ecological contexts.

Background: COVID-19 vaccination hesitancy and acceptance remain critical public health concerns, influenced by socio-cultural factors globally. Social influence - particularly conformity, compliance and obedience - influence vaccination intentions, decisions and behaviours based on the information circulated by the people already vaccinated. Understanding these dynamics is essential for promotion vaccine uptake through reassuring the hesitant about the safety and effectiveness of the vaccine.

Aim: We explored the influence of social influence on COVID-19 vaccination hesitancy and acceptance in Tanzania.

Setting: Our study was conducted in eight regions of Mainland Tanzania: Arusha, Morogoro, Mtwara, Njombe, Mbeya, Tabora, Singida and Shinyanga, to represent eight zones of Mainland Tanzania.

Methods: We adopted a mixed-methods research approach, to collect data from 3098 respondents for a quantitative part, and 336 key informants as well as 376 participants for focus group discussions. Data analysis involved both descriptive and inferential statistics for quantitative data as well as thematic analysis for qualitative data.

Results: There was regional variation in vaccination rates, with Mtwara and Singida showing high acceptance at 50% and 49.7%, respectively, while Morogoro (22.5%) and Mbeya (26.2%) showed lower rates. Social influence, especially friends, family, and community discussions, and trust in the government as a reliable source of information regarding the COVID-19 vaccination were key. Changes in the Tanzanian government's political will also contributed to positive attitudes regarding COVID-19 vaccination acceptance.

Conclusion: Social influence influenced COVID-19 vaccination acceptance in Tanzania, requiring tailored public health strategies involving the government, trusted community figures and considering social ties and social interaction to boost vaccination rates.

Contribution: Our study offers insights on the critical role of social influence on COVID-19 vaccination hesitancy and acceptance; hence, a necessity for socio-cultural context-specific and participatory interventions in a quest to reduce COVID-19 vaccination hesitancy and improve acceptance in the Tanzanian context.