Potential factors influencing COVID-19 vaccine acceptance and hesitancy among university students in Bangladesh: a cross-sectional comparative study.

This study investigated Coronavirus disease 2019 (COVID-19) vaccine acceptance, and compared the potential factors influencing vaccine acceptance and hesitancy between public university (PuU) and private university (PrU) students in Bangladesh. An anonymous, self-administered questionnaire was sent to 640 PuU and 660 PrU students in Google Form between 25th September and 22nd November 2021, which resulted in the participation of 1034 (461 PuU vs. 573 PrU) respondents (response rate: 72.03% vs. 86.81%). The pooled vaccine acceptance rates among PuU and PrU students were almost similar (88.1%, 95% confidence interval (CI) 85.1-91.1 vs. 87.6%, 95% CI 84.6-90.6). Employing binary logistic regression to assess the association between various potential factors and vaccine acceptance, the study revealed that out of 10 predictors, 'safety' and 'efficacy' had highly significant positive associations with vaccine acceptance in both cohorts (P = 0.000, P = 0.005). 'Political roles' was found to have varied effects- a significant (P = 0.02) negative and a significant positive (P = 0.002) association with vaccine acceptance in PuU and PrU students, respectively. Additionally, 'communication' (P = 0.003) and 'trust' (P = 0.01) were found to have significant positive associations in PrU students while 'rumours' (P = 0.03) had negative association in PuU students. The odds of accepting the COVID-19 vaccine were 1.5 vs. 0.9 in PuU and PrU students. Although chi-square analysis did not show any significant association between gender and vaccine acceptance, discrepancies were found in the factors that potentially affect vaccine uptake decision between PuU and PrU students. COVID-19 vaccine uptake may be improved if vaccine-related information becomes available and is communicated to large numbers of people effectively. The implementation of multidisciplinary interventional educational programmes may also be considered as a preferred approach to improve student's engagement in pandemic awareness and vaccine readiness.

Potential clinically significant drug-drug interactions of hydroxychloroquine used in the treatment of COVID-19.

AIMS: Hydroxychloroquine (HCQ) is using as a repurposed drug in considerable proportion of COVID-19 patients. However, being a substrate of cytochrome P450 (CYP) enzymes of CYP3A4/5, CYP2C8 and CYP2D6, the safety and efficacy of this drug may be affected by the coadministration of respective CYP inhibitors, substrates or inducer drugs. It was aimed to identify potential clinically significant drug-drug interaction (DDI) pairs of HCQ. METHODS: Inhibitors, substrates and inducer drugs lists of CYP enzymes of interest from international well-recognised evidence-based drug interaction resources were used to identify potential clinically significant pharmacokinetic DDI pairs of HCQ. RESULTS: Among 329 identified interacting drugs that predicted to cause clinically significant DDIs of HCQ, 45 (13.7%), 43 (13.1%) and 123 (37.4%) unique DDI pairs were identified from the FDA, Stockley's and Flockhart lists, respectively. Of interest, 55 (16.7%) DDI pairs were recognised by all three resources. At least, 29 (8.8%) severe DDI pairs were identified predicted to cause severe toxicity of HCQ in patients with COVID-19. When comparing these interactions with Liverpool DDI lists, it was found that out of 423 total interactions, 238 (56.3%) and 94 (22.2%) unique DDI pairs were identified from all three resources and Liverpool DDI lists, respectively. Of interest, only three (0.7%) DDI pairs were recognised by both the three international resources and Liverpool DDI lists of HCQ. CONCLUSION: Using HCQ has clinical debate whether it should or should not continue in COVID-19 patients, however, potential clinically significant DDIs identified in this study may optimise safety or efficacy of HCQ in considerable proportion of patients.

Prescription antibiotics for outpatients in Bangladesh: a cross-sectional health survey conducted in three cities.

BACKGROUND: Antibiotics prescribing by physicians have gained due importance across the globe, mainly because of an increase in antibiotic usage, prevalence of infections and drug resistances. The present study is aimed to evaluate the physicians prescribing pattern of antibiotics, their usages by outpatients and disease conditions for which the antibiotics are prescribed in three cities of Bangladesh. METHODS: This cross sectional health survey was carried out with a self designed standard questionnaire by manual data collection over a three months period (20.03.2013 to 20.06.2013) at three adjacent cities Jessore Sadar, Monirampur and Keshabpur upazila respectively. The data were collected from the patient's prescription and by directly interviewing the patients who were prescribed at least one antibiotic during the study period. WHO Anatomical Therapeutic Chemical (ATC) classifications for antibiotics was used and descriptive statistics were applied to the collected data and analyzed using Microsoft Excel software. Modified Wald method was applied to calculate 95% CI. RESULTS: A total of 900 prescriptions were analyzed during the study period. It was found that the prescriber prescribed antibiotics to the patients who were suffering mainly from cold and fever, infections, diarrhea and gonorrhea. The highest prescribed antibiotic groups were cephalosporins (31.78%), macrolides (27.33%), quinolones (16.33%), penicillins (7.11%), and metronidazoles (6.78%) respectively. Two or more antibiotics were prescribed in 25.44% of prescriptions. A total of 66.89% prescriptions had complete information on dosage form, 57% had complete direction for antibiotics use and 64.22% patients completed full course of antibiotics. Although 83% prescriptions have no clinical test for using antibiotics, even though the percentages of patients' disease recovery were 61.78% and in compliance were 38.22%. CONCLUSION: From this research, it is observed that physicians prescribed antibiotics rationally in some cases but needs to ensure in all cases of prescription. Because irrational use leads to the spread of bacterial resistance to antibiotics and related health problems, our findings have important implications for public education and the enforcement of regulations regarding the prescription of antibiotics in Bangladesh.

Global disparities in COVID-19 vaccine booster dose (VBD) acceptance and hesitancy: An updated narrative review.

The global deployment of COVID-19 vaccine booster dose (VBD) has been recognized as a promising therapeutic alliance to provide repeated immunity against the arrival of new variants. Despite scientific evidence supports the effectiveness of periodic doses, COVID-19 vaccine booster reluctance continues to thrive. This narrative review aimed to examine global COVID-19 vaccine booster dose (VBD) acceptance and summarize an up-to-date assessment of potential antecedents associated with VBD acceptance. A comprehensive search was performed in several reputable databases such as Medline (via PubMed), Scopus, Google scholar, and Web of Science from June 10th, 2023, to August 1st, 2023. All relevant descriptive and observational studies on COVID-19 VBD acceptance and hesitancy were included in this review. A total of fifty-eight (58) studies were included, with Asia representing the highest count with thirty-one (53%) studies, Europe with eleven (19 %), the United States with nine (16 %), and other regions (Africa and multi-ethnic) with seven (12 %). Worldwide, the pooled COVID-19 VBD acceptance rate was 77.09 % (95 % CI: 76.28-78.18), VBD willingness (n) = 164189, and the total sample (N) = 212,990. The highest and the lowest VBD acceptance rate was reported in Europe and American regions, respectively, 85.38 % (95 % CI: 85.02-85.73, (n) = 32,047, (N = 37,533) vs. 66.92 % (95 % CI: 66.56-67.4), (n) = 29335, (N) = 43,832. However, Asia and multi-ethnic areas reported moderately high VBD acceptance rate 79.13 % (95 % CI: 78.77-79.23, (n) = 93,994, (N) = 11,8779) and 72.16 % (95 % CI: 71.13-72.93, (n) = 9276, (N) = 12,853), respectively. The most common and key antecedents of COVID-19 VBD acceptance and hesitancy across the countries were "equal safety", "efficacy", "effectiveness", "post-vaccination side effects", "community protection" "family protection", "risk-benefit ratio", "booster necessity", "trust", and "variants control". Disparities in the uptake of COVID-19 VBD were observed globally, with the highest rates found in Europe, and the lowest rates in American regions. Multiple potential antecedents including safety, efficacy, and post-vaccination side effects were associated with VBD acceptance and hesitancy.

Multi-dimensional potential factors influencing COVID-19 vaccine booster acceptance and hesitancy among university academic community in Bangladesh: A cross-sectional comparative study.

BACKGROUND AND AIMS: Vaccination is the most powerful public health intervention proven to be safe and effective in the battle against the coronavirus disease-2019 (COVID-19) pandemic. Despite the potential therapeutic benefits of primer vaccine dosage regimens, public perceptions of COVID-19 vaccine booster dose (VBD) acceptance and hesitancy vary among various sub-group populations. This study investigates COVID-19 vaccine booster dose acceptance and compares the multi-dimensional potential factors influencing VBD acceptance and hesitancy among university teachers and the student community in Bangladesh. METHODS: This web-based cross-sectional study employed an anonymous, validated, and self-administered questionnaire. The questionnaire items were adopted from a theoretical analysis of the recent relevant literature. The questionnaire was deployed in an on-line-enabled format (Google form) and conveniently distributed to 685 teachers and 990 students between 15th June, 2022 and 15th August, 2022 which resulted in the participation of 1250 (505 teachers vs.745 students) total respondents (response rate 73.72% vs. 75.25%) from various universities in Bangladesh. A non-parametric analytical tool (binary logistic regression) was applied to rationalize the study objectives and a Chi-squared test was performed to estimate the booster- hesitant risky group. RESULTS: The pooled COVID-19 vaccine booster dose acceptance rates were 84.6% (95% CI 81.5─87.7) and 67.2% (95% CI 63.8─70.6) for teachers and students in the university academic community, respectively. In employing a binary logistic regression, this study revealed that out of twelve (12)multi-dimensional key predictors, "equal safety", "risk-benefit ratio", and "variant control" had a significant positive association with VBD acceptance in both sets (p = 0.000, p = 0.000, and p = 0.005, respectively). Varied effects were found for several predictors; post-vaccination "side effects" had a significant negative association (p = 0.020) and "community protection" had significant positive association (p = 0.034) with vaccine booster dose acceptance in the teachers community while these variables were insignificant in the students cohort. "Trust" had a highly significant positive association (p = 0.000);"communication" and "academic attainment" had significant positive associations (p = 0.033 and 0.024, respectively) with VBD acceptance in the students cohort, while these predictors were insignificant in the teachers community. Women were more likely to receive a third dose of the vaccine (OR = 1.4 vs. 0.9 between teacher and student model); however, no significant association between gender and booster vaccine acceptance was found in a comparative Chi-squared model. Therefore, statistically, the booster vaccine-hesitant risky group was not found to implicate the massive booster vaccine drive among the university academic community. CONCLUSIONS: COVID-19 booster vaccine acceptability among the student cohort was slightly lower than pre-roll-out intent. The teacher community was more inclined to get booster vaccinated. Moreover, differences were found between the multi-dimensional potential factors associated with VBD acceptance among teachers and students in university settings. This study explicitly confirmed positive attitudes toward the safety, health benefits, and variants control of the COVID-19 VBD under any circumstances. Post-vaccination side effect concern was found to be a barrier to administering booster shots and a reason for booster skepticism. Tailored communication and health education interventions need to be adopted to improve the public awareness of booster vaccine consequences, and limit booster skepticism.

Acceptance of COVID-19 vaccine booster dose among the people of Bangladesh: A cross-sectional study.

Vaccine booster dose (VBD) provides a potential therapeutic alliance in preventing breakthrough infection and new variant's arrival while preserving long-lasting host immunity. This study aimed to analyze COVID-19 VBD willingness and identified the key determinants of VBD acceptance among the general people of Bangladesh. This survey-based study applied a quantitative research paradigm. A validated, anonymous, and multi-item questionnaire was adopted through a theoretical review of pertinent literature on the topic. Data were collected between August 2022─October 2022, and sampling was done randomly. A total of 704 individuals were invited via face-to-face interview approach; however, 13.8 % of them declined to give consent, which resulted in the participation of 607 potential respondents. The main outcome measure was COVID-19 VBD acceptance willingness. Binary logistic regression analysis was conducted to rationalize the study's objectives. The pooled COVID-19 booster vaccine acceptance rate was 70.0 % (95 % confidence Interval [CI]: 67─73) among Bangladeshi people. An analysis of binary logistic regression revealed that, out of 14 potential factors, "efficacy", "repeated immunity", "communication", and "trust" showed highly significant positive association (adjusted odds ratio [aOR ] = 2.151 95 % CI: 1.391─ 3.508, aOR = 2.033 95 % CI: 1.299─ 3.181, and aOR = 2.552 95 % CI: 1.557─4.183 respectively, p<0.01), and "equal safety", "risk-benefit ratio" and "community protection" had significant positive association (aOR = 1.739 95 % CI: 1.070─2.825, aOR = 1.712 95 % CI: 1.116─2.627, and aOR = 1.628 95 % CI: 1.395─0.998, p<0.05) with VBD acceptance. However, post-vaccination "side effects" showed significant negative (aOR = 0.393 95 % CI: 0.237─0.674, p<0.01) associations with VBD acceptance. The odds of accepting the COVID-19 vaccine booster was found 1.26, and it was found insignificant (p>0.05) in the Chi-squared test. Bangladeshi people expressed a moderately high level response to COVID-19 VBD acceptance. A positive attitude towards the COVID-19 VBD is an outcome of this study, regardless of the circumstances, as far as safety, efficacy, perceived health benefits, communication, trust, and community resistance are concerned. Post-vaccination side effects fear was the primary reason for booster dose skepticism as well as a barrier to administering booster shots. The confidence in COVID-19 VBD will be boosted when mass people are effectively communicated and vaccine's data become more available publicly.

Potential determinants of childhood COVID-19 vaccine confidence among the primary school's stakeholders in Bangladesh: A cross-sectional study to assess the effects of education.

BACKGROUND: Rapid corona virus disease 2019 (COVID-19) vaccination drives aimed to immunize primary school-aged youth have a potential for health safety and supportive academic attainment. This study aimed to identify the potential factors influencing childhood COVID-19 vaccine confidence among the primary school's stakeholders in Bangladesh and assess the effects of health education on vaccine confidence and receptivity. MATERIALS AND METHODS: This cross-sectional study used a bilingual, multi-item, closed-ended, anonymous questionnaire adopted from the extant literature studies on the topic. Data were collected purposively by the face-to-face interview approach. In total, 627 primary school's stakeholders participated in this study. The binary logistic regressions and Chi-square tests were employed to investigate and rationalize the study-outlined objectives where <0.05 was considered statistically significant. RESULTS: The pooled childhood vaccine confidence and receptivity against COVID-19 was 91% (95% CI 89-93) among the primary school's stakeholders. The regression analysis revealed that of eight potential determinants of vaccine confidence, "safety" and "effectiveness" had a highly significant (P = 0.006, P = 0.001, respectively) and positive association and "efficacy" had a significant (P = 0.03) and positive association, while "rumor" had a highly significant (P = 0.000) and negative association with childhood vaccine confidence. The analysis also showed that"health education" had a significant (P = 0.04) and positive association with childhood vaccine confidence and receptivity against COVID-19. Although the odds ratio for receiving childhood vaccine was found to be 0.6, the result was insignificant (P > 0.05) in the Chi-squared test. Hence, there was no vaccine-hesitant risky recipient group identified in implementing upcoming childhood COVID-19 vaccination programs. CONCLUSIONS: This study confirms the importance of a positive perception of vaccine safety, efficacy, effectiveness, and health education for vaccine confidence under any circumstances. Childhood COVID-19 vaccine confidence is Improved if vaccination data become more available to the guardians and school community. Public health education would be considered a preferred approach for building trust and fostering childhood vaccine confidence against COVID-19 in Bangladesh.

Factors influencing COVID-19 vaccine acceptance and hesitancy among rural community in Bangladesh: A cross-sectional survey based study.

Although more than one hundred million beneficiaries were administered COVID-19 vaccine until 20th February, 2022 in Bangladesh; however, proportionally a low turnout has been recorded in rural places and a substantial gap exist among the people living in rural and urban areas concerning the ratio of receiving vaccine. This study aims to investigate COVID-19 vaccine acceptance intention and to identify the potential factors influencing vaccine acceptance and hesitancy among the rural community in Bangladesh. A bilingual, self-administered anonymous questionnaire was developed, and data were collected between 10th June 2021 and 14th August 2021 through face-to-face interview. 655 rural people participated in this cross-sectional study, and sampling was done randomly. Descriptive statistics and binary logistic regressions were used to explore and rationalize study objectives. Out of 655 rural participants, 552 (84.3%, 95% CI 81.2─86.8) responded to accept COVID-19 vaccine; however, minor fractions (n = 5, n% = 0.8, 95% CI 0.12-1.4) of rural community had willingness to pay (WTP) for a COVID-19 vaccine. The result of binary regression showed that "safety," "side effects," "effectiveness," and "trust" had highly significant (p <.01) and positive correlation with vaccine acceptance intention. "Rumor" had moderately significant (p <.05) and negative association while "gender" had insignificant correlation with vaccine acceptance intention. Easy and constant access to evidence-based and trustworthy information on vaccination consequences is imperative for resource-less remote people. Health communication regarding safety, side effect, and effectiveness of vaccines were identified as the most important predictor to convert vaccines to vaccinations and for ensuring mass immunization against COVID-19 in Bangladesh.

Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review.

BACKGROUND AND AIMS: Although vaccines are considered the most effective and fundamental therapeutic tools for consistently preventing the COVID-19 disease, worldwide vaccine hesitancy has become a widespread public health issue for successful immunization. The aim of this review was to identify an up-to-date and concise assessment of potential factors influencing COVID-19 vaccine acceptance and refusal intention, and to outline the key message in order to organize these factors according to country count. METHODS: A systematic search of the peer-reviewed literature articles indexed in reputable databases, mainly Pub Med (MEDLINE), Elsevier, Science Direct, and Scopus, was performed between21stJune 2021 and10th July 2021. After obtaining the results via careful screening using a PRISMA flow diagram, 47 peer-reviewed articles met the inclusion criteria and formed the basic structure of the review. RESULTS: In total, 11 potential factors were identified, of which the greatest number of articles (n = 28) reported "safety" (34.46%; 95% CI 25.05─43.87) as the overarching consideration, while "side effects" (38.73%; 95% CI 28.14─49.32) was reported by 22 articles, which was the next common factor. Other potential factors such as "effectiveness" were identified in 19 articles (29.98%; 95% CI 17.09─41.67), followed by "trust" (n = 15 studies; 27.91%; 95% CI 17.1─38.73),"information sufficiency"(n = 12; 34.46%; 95% CI 35.87─63.07),"efficacy"(n = 8; 28.73%; 95% CI 9.72─47.74), "conspiracy beliefs" (n = 8; 14.30%; 95% CI 7.97─20.63),"social influence" (n = 6; 42.11%; 95% CI 14.01─70.21), "political roles" (n = 4; 16.75%; 95% CI 5.34─28.16), "vaccine mandated" (n = 4; 51.20%; 95% CI 20.25─82.15), and "fear and anxiety" (n = 3; 8.73%; 95% CI 0.59─18.05). The findings for country-specific influential vaccination factors revealed that, "safety" was recognized mostly (n = 14) in Asian continents (32.45%; 95% CI 19.60─45.31), followed by the United States (n = 6; 33.33%; 95% CI12.68─53.98). "Side effects" was identified from studies in Asia and Europe (n = 6; 35.78%; 95% CI 16.79─54.77 and 16.93%; 95% CI 4.70─28.08, respectively), followed by Africa (n = 4; 74.60%, 95% CI 58.08─91.11); however, public response to "effectiveness" was found in the greatest (n = 7) number of studies in Asian countries (44.84%; 95% CI 25─64.68), followed by the United States (n = 6; 16.68%, 95% CI 8.47─24.89). In Europe, "trust" (n = 5) appeared as a critical predictor (24.94%; 95% CI 2.32─47.56). "Information sufficiency" was identified mostly (n = 4) in articles from the United States (51.53%; 95% CI = 14.12─88.74), followed by Asia (n = 3; 40%; 95% CI 27.01─52.99). More concerns was observed relating to "efficacy" and "conspiracy beliefs" in Asian countries (n = 3; 27.03%; 95% CI 10.35─43.71 and 18.55%; 95% CI 8.67─28.43, respectively). The impact of "social influence" on making a rapid vaccination decision was high in Europe (n = 3; 23.85%, 95% CI -18.48─66.18), followed by the United States (n = 2; 74.85%). Finally, "political roles" and "vaccine-mandated" were important concerns in the United States. CONCLUSIONS: The prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy varied globally; however, the global COVID-19 vaccine acceptance relies on several common factors related to psychological and, societal aspect, and the vaccine itself. People would connect with informative and effective messaging that clarifies the safety, side effects, and effectiveness of prospective COVID-19 vaccines, which would foster vaccine confidence and encourage people to be vaccinated willingly.

Potential factors influencing COVID-19 vaccine acceptance and hesitancy among Bangladeshi people: a cross-sectional study.

Although vaccines are the most effective tool for preventing infectious disease, COVID-19 vaccination coverage among Bangladeshi mass people was facing challenges because large proportions were hesitant to accept a new vaccine. This study aims to investigate COVID-19 vaccine acceptance intention and to explore the potential factors influencing vaccine acceptance and hesitancy among the Bangladeshi people. A bilingual, self-administered anonymous questionnaire was developed and deployed and mixed-mode approaches (face-to-face and on-line survey) in data collection procedure were applied from 03rd May to 20th June, 2021. In total, 782 Bangladeshi people were participated in this study through random and snowballing sampling technique. Descriptive statistics and binary logistic regression analysis was employed to explore and rationalize the study objectives. Empirical findings revealed that, 69.4% (95% CI 66.1-72.7) respondents had the hesitation to accept newly promoted vaccines. The binary analysis revealed that, "safety" and "efficacy" had highly significant (p < 0.01) and positive association with vaccine acceptance. "Communication" had positive and moderately significant (p < 0.05) association; "culture" had positive and significant (p < 0.1) association while "rumor" associated moderate significantly (p < 0.05) and negatively with COVID-19 vaccine acceptance. According to the Pearson's Chi-Square test, male had highly significant (p < 0.01) willingness to receive vaccines than female gender (OR = 0.501). The prevalence of COVID-19 vaccine hesitancy could be minimized by providing vaccine safety, side effect and, efficacy data to the community through effective communication. Health awareness campaign in remote areas would remove anti-vaccination beliefs and rumors; thus foster COVID-19 vaccine confidence among the culturally motivated Bangladeshi people.

In Vivo Bioactivities of Hoya parasitica (Wall.) and In Silico Study against Cyclooxygenase Enzymes.

Hoya parasitica (Wall.) is extensively used in traditional medicine for the treatment of various diseases including rheumatism, kidney problems, jaundice, urinary tract disorders, fever, and pain. The present study was designed to explore new lead compound(s) to alleviate pain, pyresis, and diarrhea from methanol, ethyl acetate, and n-hexane extracts of H. parasitica (Wall.) leaves (MHP, EAHP, and NHP, respectively). Analgesic activity of the extracts was assessed through acetic acid induced writhing, tail immersion, and hot plate tests while brewer's yeast-induced pyrexia test was employed for the assessment of antipyretic activity. Besides, castor oil and magnesium sulfate induced diarrheal tests were utilized for the evaluation of antidiarrheal properties. Moreover, in silico study of the isolated compounds was undertaken to seek out best-fit phytoconstituent(s) against cyclooxygenase enzymes. MHP revealed substantial antioxidant activities in different in vitro assays compared to EAHP and NHP. In the acetic acid-induced writhing test, among the extracts, MHP (400 mg/kg) revealed maximum 74.15 ± 1% inhibition of writhing comparable to that of standard (85.77 ± 1.39%). Again, in tail immersion and hot plate tests, higher doses of all the test samples exhibited a significant increase of latent period in a time-dependent manner. In brewer yeast-induced pyrexia test, at 3rd and 4th hour of treatment, significant (P < 0.05) antipyretic action was found in the test samples. In both castor oil and magnesium induced diarrheal tests, MHP at 400 mg/kg showed the highest percent inhibition of diarrhea (68.62 ± 4.74 and 64.99 ± 2.90, respectively). Moreover, molecular docking analysis corroborated the results of the present study. The findings of the present study supported the traditional uses of this plant for the alleviation of pain and fever. Furthermore, hoyasterone was found to be the most effective lead compound as cyclooxygenase enzyme inhibitor.