How likely are Eastern European and central Asian countries to achieve global NCD targets: multi-country analysis.

BACKGROUND: In Europe, mortality rates from noncommunicable diseases (NCDs) among persons 30-69 years of age ("NCD premature mortality rates") have declined significantly, except in twelve countries of Eastern Europe and Central Asia, namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Data on long-term trends in NCD mortality in these countries are limited. We analyzed NCD premature mortality rates, identified change points in NCD mortality trends and forecasted how likely countries are to achieve the global NCD targets, stratified by gender and NCD type. METHODS: We used the 1990-2019 Global Burden of Disease database to analyze NCD trends and identified country-specific change points by using piecewise linear regression. We assessed the likelihood of achieving the global targets for reducing NCD premature mortality rates among persons 30-69 years of age from four NCDs: cancers, diabetes, cardiovascular and chronic respiratory diseases. The global NCD targets are 25% reduction in mortality from 2010 to 2025 (WHO 25X25 target) and 33%-from 2015 to 2030 (SDG 3.4.1). We applied the analysis to both genders and four NCDs. RESULTS: Only Kazakhstan and Russia are likely to achieve the global NCD targets. For Kazakhstan, WHO 25X25 and SDG 3.4.1 global targets for mortality rates were 494.3 and 374.8 per 100,000 population respectively; the corresponding predicted values (PVs) were 360.6 [CI 260.1-461.1] and 245.1 [CI 113.4-376.8]. For Russia, WHO 25X25 and SDG 3.4.1 global targets were 560.5 and 442.8 per 100,000 population respectively; the corresponding PVs were 427.7 [CI 270.3-585.1] and 311.0 [CI 102.8-519.1]. Achieving NCD global targets is less likely for Kyrgyzstan, while it is unlikely for the rest of countries. Most countries had higher mortality rates and slower progress among men compared with women. The likelihood of achieving overall global NCD targets was mainly explained by reduction in cardiovascular mortality. CONCLUSIONS: In most Eastern Europe and Central Asia countries, progress towards achieving NCD global targets is slow, or there's a reverse trend. Further quantitative and qualitative research is needed to understand the underlying reasons. Separate indicators are needed to monitor trends for cancers, diabetes and chronic respiratory diseases.

Estimated relative potential for airborne SARS-CoV-2 transmission in a day care centre.

We estimated the hourly probability of airborne severe acute respiratory coronavirus 2 (SARS-CoV-2) transmission and further the estimated number of persons at transmission risk in a day care centre by calculating the inhaled dose for airborne pathogens based on their concentration, exposure time and activity. Information about the occupancy and activity of the rooms was collected from day care centre personnel and building characteristics were obtained from the design values. The generation rate of pathogens was calculated as a product of viral load of the respiratory fluids and the emission of the exhaled airborne particles, considering the prevalence of the disease and the activity of the individuals. A well-mixed model was used in the estimation of the concentration of pathogens in the air. The Wells-Riley model was used for infection probability. The approach presented in this study was utilised in the identification of hot spots and critical events in the day care centre. Large variation in the infection probabilities and estimated number of persons at transmission risk was observed when modelling a normal day at the centre. The estimated hourly infection probabilities between the worst hour in the worst room and the best hour in the best room varied in the ratio of 100:1. Similarly, the number of persons at transmission risk between the worst and best cases varied in the ratio 1000:1. Although there are uncertainties in the input values affecting the absolute risk estimates the model proved to be useful in ranking and identifying the hot spots and events in the building and implementing effective control measures.

Knowledge, risk perception and uptake of COVID-19 vaccination among internally displaced persons in complex humanitarian emergency setting, Northeast Nigeria.

BACKGROUND: Owing to crowded and unsanitary conditions, internally displaced persons (IDPs) have an increased risk of COVID-19 infection. Adoption of COVID-19 preventive measures among this population is premised on accurate information, adequate knowledge, and risk perception. We assessed COVID-19 knowledge and risk perception and investigated the association between risk perception and COVID-19 preventive measures, including vaccination among IDPs in Northeast Nigeria. METHODS: We conducted a cross-sectional study during July-December 2022 and sampled 2,175 IDPs using stratified sampling. We utilized a 12-point assessment tool to evaluate COVID-19 knowledge. Participants who scored ≥ 6 points were considered to have adequate knowledge. We used a 30-item Risk Behavior Diagnosis Scale to assess COVID-19 risk perception and evaluated each item on a 5-point Likert scale. Participants were divided into risk perception categories by the median of Likert scale scores. We performed weighted logistic regression analysis to identify factors associated with risk perception. Pearson's chi-squared with Rao-Scott adjustment was used to determine the relationship between risk perception and COVID-19 preventive measures. RESULTS: Of 2,175 participants, 55.7% were 18-39 years old, 70.9% were females, and 81.7% had no formal education. Among the IDPs, 32.0% (95% CI: 28.8 - 35.0) were considered to have adequate COVID-19 knowledge, and 51.3% (95% CI: 47.8 - 54.8) perceived COVID-19 risk as high. Moreover, 46.3% (95% CI: 42.8 - 50.0) had received one dose of COVID-19 vaccine, and 33.1% (95% CI: 29.8 - 36.0) received two doses. Adequate knowledge (Adjusted Odds Ratio (AOR) = 2.10, [95% CI: 1.46 - 3.03]) and post-primary education (AOR = 3.20, [95% CI: 1.59 - 6.46]) were associated with risk perception. Furthermore, high risk perception was significantly associated with wearing face masks (χ2 = 106.32, p-value < .001), practicing hand hygiene (χ2 = 162.24, p-value < .001), physical distancing (χ2 = 60.84, p-value < .001) and vaccination uptake (χ2 = 46.85, p-value < .001). CONCLUSIONS: This study revealed gaps in COVID-19 knowledge, risk perception, and vaccination uptake but demonstrated a significant relationship between risk perception and COVID-19 preventive practices. Health education and risk communication should be intensified to improve knowledge, elicit stronger risk perception, and enhance COVID-19 preventive practices.

Factors associated with health-seeking patterns among internally displaced persons in complex humanitarian emergency, Northeast Nigeria: a cross-sectional study.

BACKGROUND: Currently, over two million persons are internally displaced because of the complex humanitarian emergency in Nigeria's northeast region. Due to crowded and unsanitary living conditions, the risk of communicable disease transmission, morbidity, and mortality among this population is high. This study explored patterns and factors associated with health-seeking among internally displaced persons (IDPs) in northeast Nigeria to inform and strengthen disease surveillance and response activities. METHODS: In a cross-sectional study conducted during June-October 2022, we employed stratified sampling technique to select 2,373 IDPs from 12 IDPs camps. A semi-structured tool was used to collect data on health-seeking patterns, socio-demographics, households, and IDPs camps characteristics. We classified health-seeking patterns into three outcome categories: 'facility care' (reference category), 'non-facility care' (patent medicine vendors, chemists, traditional healers, religious centers), and 'home care/no care'. We performed complex survey data analysis and obtained weighted statistical estimates. Univariate analysis was conducted to describe respondents' characteristics and health-seeking patterns. We fitted weighted multivariable multinomial logistic regression models to identify factors associated with health-seeking patterns. RESULTS: Of 2,373 respondents, 71.8% were 18 to 39 years old, 78.1% were females, and 81.0% had no formal education. Among the respondents, 75.7% (95% CI: 72.9-78.6) sought 'facility care', 11.1% (95% CI: 9.1-13.1) sought 'non-facility care', while 13.2% (95% CI: 10.9-15.4) practiced 'home care/no care'. Respondents who perceived illness was severe (Adjusted Odds Ratio (AOR) = 0.15, [95% CI: 0.08-0.30]) and resided in officially-recognized camps (AOR = 0.26, [95% CI: 0.17-0.39]) were less likely to seek 'non-facility care' compared to 'facility care'. Similarly, respondents who resided in officially-recognized camps (AOR = 0.58, [95% CI: 0.36-0.92]), and received disease surveillance information (AOR = 0.42, [95% CI: 0.26-0.67) were less likely to practice 'home care/no care' rather than seek 'facility care'. CONCLUSIONS: This population exhibited heterogeneous patterns of health-seeking at facility and non-facility centers. Perception of illness severity and camps' status were major factors associated with health-seeking. To enhance surveillance, non-facility care providers should be systematically integrated into the surveillance network while ramping up risk communication to shape perception of illness severity, prioritizing unofficial camps.

Qualitative Insights into Vaccine Uptake of Nursing Staff in Long-Term Care Facilities in Finland.

Vaccine hesitancy and refusal have undermined COVID-19 vaccination efforts of nursing staff. This study aimed to identify behavioral factors associated with COVID-19 vaccine uptake among unvaccinated nursing staff in long-term care facilities (LTCF) in Finland. Methodology: The study was based on the Theoretical Domains Framework. Data were collected through qualitative in-depth interviews among nursing staff and managers of LTCFs. The analysis was based on thematic analysis. We identified seven behavioral domains, with several themes, that reduced the staff's intention to get vaccinated: knowledge (information overload, inability to identify trustworthy information sources, lack of vaccine-specific and understandable scientific information), beliefs about consequences (incorrect perceptions about the vaccine effectiveness, and lack of trust in the safety of the vaccine), social influences (influence of family and friends), reinforcement (limited abilities of the management to encourage vaccination), beliefs about capabilities (pregnancy or desire to get pregnant), psychological factors (coping with changing opinion), and emotions (confusion, suspicion, disappointment, and fatigue). We also identified three behavioral domains that encouraged vaccine uptake: social influences (trust in health authorities), environmental context and resources (vaccination logistics), and work and professional role (professional pride). The study findings can help authorities to develop tailored vaccine promotion strategies for healthcare workers in LTCFs.

Assessment of Food and Waterborne Viral Outbreaks by Using Field Epidemiologic, Modern Laboratory and Statistical Methods-Lessons Learnt from Seven Major Norovirus Outbreaks in Finland.

Seven major food- and waterborne norovirus outbreaks in Western Finland during 2014-2018 were re-analysed. The aim was to assess the effectiveness of outbreak investigation tools and evaluate the Kaplan criteria. We summarised epidemiological and microbiological findings from seven outbreaks. To evaluate the Kaplan criteria, a one-stage meta-analysis of data from seven cohort studies was performed. The case was defined as a person attending an implicated function with diarrhoea, vomiting or two other symptoms. Altogether, 22% (386/1794) of persons met the case definition. Overall adjusted, 73% of norovirus patients were vomiting, the mean incubation period was 44 h (4 h to 4 days) and the median duration of illness was 46 h. As vomiting was a more common symptom in children (96%, 143/149) and diarrhoea among the elderly (92%, 24/26), symptom and age presentation should drive hypothesis formulation. The Kaplan criteria were useful in initial outbreak assessments prior to faecal results. Rapid food control inspections enabled evidence-based, public-health-driven risk assessments. This led to probability-based vehicle identification and aided in resolving the outbreak event mechanism rather than implementing potentially ineffective, large-scale public health actions such as the withdrawal of extensive food lots. Asymptomatic food handlers should be ideally withdrawn from high-risk work for five days instead of the current two days. Food and environmental samples often remain negative with norovirus, highlighting the importance of research collaborations. Electronic questionnaire and open-source novel statistical programmes provided time and resource savings. The public health approach proved useful within the environmental health area with shoe leather field epidemiology, combined with statistical analysis and mathematical reasoning.

Higher pneumococcal disease vaccination rates needed to protect more at-risk US adults.

Pneumococcal disease, which includes pneumococcal pneumonia, meningitis, and bacteremia, is associated with substantial morbidity, mortality, and health care costs in adults. Advanced age, chronic lung or cardiovascular disease, immunosuppressive conditions, and smoking increase the risk for infection. Despite the availability of an effective pneumococcal polysaccharide vaccine (PPSV23), vaccination rates among adults remain suboptimal. This is of immediate concern given the current H1N1 pandemic, since secondary bacterial infection with Streptococcus pneumoniae is common and can contribute to morbidity and mortality. The Centers for Disease Control and Prevention has recently called for increased efforts to vaccinate recommended persons against pneumococcal disease. Long-term trends including the growth of the elderly population and an increase in the number of patients with chronic conditions also underscore the importance of improving pneumococcal vaccination rates. It is important for health care providers, public health officials, and policy makers to recognize the serious health impact of pneumococcal disease in adults and to ensure increased coverage; at present, this is the best way to protect against invasive pneumococcal infection and its consequences.