Factors for hesitancy towards vaccination against COVID-19 among the adult population in Puducherry, India - a cross sectional study.

BACKGROUND: Vaccine hesitancy is a complex phenomenon that threatens global health. Present-day communication technology has paved the way for self-education but also contributed to the infodemic surrounding vaccination. This has resulted in pockets of people who are reluctant, refuse recommended vaccinations, or choose to delay being vaccinated. The present study was designed to estimate the magnitude of hesitancy towards the COVID-19 vaccination and determine its associated factors in the community. METHODS: This cross-sectional study was conducted among 776 adults aged ≥ 18 years in 15 clusters in Puducherry district, India, between March 2022 and May 2022. Face-to-face interviews were conducted using a validated, structured questionnaire. Socio-demographic variables, co-morbidities, attitudes towards vaccination, etc., were expressed as frequencies and percentages. Vaccine hesitancy was dichotomized with the median score as the cut-off and reported as a proportion with a 95% confidence interval. Univariate and multivariate analyses were carried out to determine the factors associated with vaccine hesitancy. RESULTS: The mean age of participants was 43.3 ± 14.8 years, with the majority being female (67.0%). Nearly 92.4%, 74.4%, and 0.5% of participants received their first, second, and precautionary doses, respectively, during the study period. Among the unvaccinated, 93.2% were unwilling to receive any dose of vaccination. More than half of the participants were hesitant towards vaccination, according to the vaccine hesitancy scale. Participants aged above 45 years were less hesitant, while those educated up to school level, belonging to the upper socio-economic class, never tested for COVID-19 in the past, and having a negative attitude towards vaccination were significantly associated with higher vaccine hesitancy. CONCLUSIONS: It is imperative to address vaccine hesitancy by alleviating existing fears and misconceptions in the community through efficient communication strategies to win the fight against current as well as future public health emergencies.

Effects of the COVID-19 Pandemic on the Lifestyle and Mental Health of Children in the Puducherry District: A Community-Based Cross-Sectional Study.

INTRODUCTION: The COVID-19 pandemic has tremendously disrupted societal behaviors and norms. People had to cope with new situations, including restrictions on free movement, home confinement, and school closures, among others. With less scope for physical classes, online classes became rampantly common during and after the pandemic. A virtual learning platform cannot replace the societal learning and preparation of children that normally occurs in school settings. The pandemic had a multifaceted impact on children, disrupting their routine work, social life, and mental health. Such uncertain circumstances are bound to interfere with their emotional well-being, with long-term consequences. It is imperative to screen for the effects of the pandemic situation among children for timely action. METHODS: A cross-sectional survey was carried out in both rural and urban areas of Puducherry, India, between February and April 2022, toward the fag end of the pandemic. Face-to-face interviews were conducted among caregivers of 621 children aged 6-17 years. Details such as sociodemographic, personal, and behavioral aspects of the child were collected. Emotional and behavioral difficulties during the pandemic were assessed using the parent (caregiver) version of the Strengths and Difficulties Questionnaire-25 (SDQ-25). Univariate analysis was performed using the chi-square test. Four different regression models were fitted to ascertain the factors influencing the overall difficulty score as well as the SDQ subscales, namely, the internalizing, externalizing, and prosocial scores. A P value of <0.05 was considered significant. RESULTS: Overall, 101 (16.3%) children aged 6-17 years were likely to have emotional and behavioral difficulties according to the SDQ scores. Abnormal externalizing, internalizing, and prosocial scores were documented among 160 (25.8%), 258 (41.5%), and 285 (45.9%) children, respectively. Caregivers reported disruptions in their children's academic performance (426, 68.6%), sleeping patterns (269, 43.3%), and eating habits (256, 41.2%). The use of digital devices for noneducational purposes was reported among 97 (35.9%) children. Younger caregivers (18-45 years), children who used digital devices for >2 hours per day, children who experienced any death due to COVID-19 in their family, and caregivers who perceived that the psychological changes in their children were due to the pandemic were predictors of abnormal SDQ scores. Physical activity for more than two hours per day reduced the risk of emotional and behavioral difficulties in children by 60%. CONCLUSIONS: This research underscores the potential ramifications of the pandemic on the mental well-being and lifestyle of children. Implementing initiatives that promote positive mental health and conducting preventive screening for vulnerable populations, such as children, are considered essential, anticipating the challenges posed by such unprecedented pandemic circumstances in the future.

Anti-Dengue Sanitation Practices: A Health Education Approach for Municipal Sanitary Workers in Puducherry, India.

Introduction Dengue is a mosquito-borne disease of global health concern, especially in tropical areas. Aedes aegypti, its vector, thrives in inadequate sanitation conditions. The role of sanitary workers is pivotal in dengue control and prevention efforts; hence, educating them is essential for enhancing their vector control awareness. Methods This study was conducted among 109 municipal sanitary workers in selected areas of Puducherry, India. Their baseline knowledge, attitudes, and practices (KAP) regarding dengue were assessed through a pretested, semi-structured questionnaire, followed by a targeted health education intervention incorporating novel communication methods such as pocket awareness cards. The impact of the intervention was assessed through an increment in KAP scores, qualitative interviews, and surprise visits to the field during their work hours. Results The mean (± SD) scores in terms of knowledge (4.29 ± 1.77 vs. 7.17 ± 1.02; p < 0.01), attitudes (3.58 ± 1.42 vs. 4.69 ± 0.71; p < 0.01), and practices (1.98 ± 0.84 vs. 4.28 ± 1.12; p < 0.01) significantly increased post-intervention. Qualitative interviews revealed the utility of the intervention, with additional insights on implementation barriers and strategies for the future. Conclusion The study's findings imply that the targeted health education intervention for sanitary workers was effective in improving their knowledge and practices on dengue control. These results demonstrate the potential of future educational initiatives to promote vector control measures among sanitary staff and thereby combat dengue transmission in the community.

Performance characteristics of STANDARD Q Filariasis Antigen test (QFAT) to detect filarial antigens of Wuchereria bancrofti in the field.

BACKGROUND: Mapping, monitoring, and evaluation of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) rely on high-throughput diagnostics. While the WHO-recommended Filariasis Test Strip (FTS) is widely used to evaluate the programme, its use is limited by some technical and operational issues. We evaluated the performance characteristics of Q Filariasis Antigen Test (QFAT) compared to FTS for detecting Wuchereria bancrofti filarial antigen in the field. METHODS: The QFAT and FTS kits were tested simultaneously for circulating filarial antigen (CFA) during an epidemiological monitoring survey (EMS) in two blocks of a filariasis endemic district in Karnataka, India, as a part of evaluation of the filariasis elimination programme with three drugs (Ivermectin, Diethylcarbamazine, and Albendazole-IDA). Blocks are considered as the evaluation unit as per the revised national guidelines. Two sentinel and one random site from each block with a sample size of 300 individuals aged ≥20 years were selected for the EMS. The field evaluation of the new kit was carried out in the four sentinel sites. Positive tests with either FTS or QFAT or both were tested for microfilaria (Mf) using night blood samples. The performance of the tests was compared in terms of sensitivity, specificity, and predictive values. The percentage agreement between the tests was verified using Cohen's kappa statistics (k), with a P value of less than 0.05 indicating statistical significance. FINDINGS: A total of 1227 individuals were tested for CFA using both the QFAT and FTS tests. The QFAT test detected 299 positive individuals at the end of 10 minutes, while the FTS detected 310 positives. The QFAT showed high sensitivity (95.5%), specificity (99.7%), positive predictive value (99.0%), and negative predictive value (98.5%), and the results were in near perfect agreement with those of the FTS (k = 0.97, P <0.001) when the results were read at 10 minutes. There were 17 discordant results that were positive according to either one of the tests. Both antigen tests were positive for all 68 microfilaria-positive samples. None of the QFAT tests were invalid, while three FTS tests were invalid due to non-flow on the test pad. There was no cross-reactivity of the QFAT with Brugia malayi-positive samples (n = 5). The feedback from the technicians indicates that QFAT tests were easier to perform compared to FTS in the field. CONCLUSIONS: The Q filariasis antigen test is a promising tool for detecting the Wuchereria bancrofti antigen. The kits may be further validated for the review of Diagnostic Technical Advisory Group for Neglected Tropical Diseases (DTAG), to be recommended for the Global Programme to Eliminate Lymphatic Filariasis (GPELF).

Coverage evaluation of mass drug administration with triple drug regimen in an evaluation unit in Nagpur district of Maharashtra, India.

BACKGROUND: Triple drug regimen (IDA; Ivermectin, Diethylcarbamazine, Albendazole) recommended for accelerating elimination of lymphatic filariasis was launched in India in December 2018. Nagpur district in Maharashtra was one of the first five districts where this strategy was introduced. The National Vector Borne Disease Control Programme (NVBDCP) at the district reported ~85.0% treatment coverage in the first round of mass drug administration (MDA) with IDA implemented in EU-2 in Nagpur district in January 2019. As per the national guideline, a coverage evaluation survey was carried out and both quantitative and qualitative data were collected to assess the treatment coverage, the level of community preparation and identify the gaps, if any, for improvement. METHODOLOGY: A Coverage Evaluation Survey (CES) following the WHO recommended protocol was conducted in one of the two evaluation units (EU-2) in Nagpur district in March 2019. Coverage Sample Builder (CSB) V2.9 tool was used to calculate the sample size, select sites and estimate drug coverage. The CSB tool followed a two-stage cluster sampling procedure to select 30 primary sampling units (ward/village as a cluster) and a list of random numbers for selecting households (HHs) in each cluster. The results were analyzed for operational indicators. Stata ver. 14.0 software was used to construct the 95% confidence limits accounting for clustering. RESULTS: A total of 1601 individuals aged 5-85 years of both gender from 328 HHs were surveyed from the 30 randomly selected clusters in EU-2. The mean age was 33.8±17.6 years. Among the surveyed population, 78.0% received the drugs (programme reach) and 66.1% consumed the drugs (survey coverage). Survey coverage was significantly higher in rural (82.6%) than in urban (59.4%) and peri-urban (58.6%) areas (P<0.001). Directly observed treatment (DOT) among the surveyed population was 51.6%. Adverse events were reported among 6.9% respondents who reported to have consumed the drugs. CONCLUSION: The IDA based MDA strategy could achieve just the required level of treatment coverage (~65%) in EU-2, Nagpur district, which had previously undergone several rounds of DA-MDAs (Diethylcarbamazine, Albendazole). Having achieved an effective treatment coverage of >80% in rural areas, the coverage in urban and peri-urban areas need to be improved in order to attain the impact of IDA-MDA. It is imperative to strengthen drug delivery and community preparation activities along with improved DOT especially in urban and peri-urban areas to achieve the required level of treatment coverage. Addition of ivermectin did not have any additional perceived adverse events.

Mapping and monitoring for a lymphatic filariasis elimination program: a systematic review.

Lymphatic filariasis (LF) is targeted for elimination by the year 2020. The Global Programme for Elimination of LF (GPELF) aims to achieve elimination by interrupting transmission through annual mass drug administration (MDA) of albendazole with ivermectin or diethylcarbamazine. The program has successfully eliminated the disease in 11 of the 72 endemic countries, putting in enormous efforts on systematic planning and implementation of the strategy. Mapping areas endemic for LF is a pre-requisite for implementing MDA, monitoring and evaluation are the components of programme implementation. This review was undertaken to assess how the mapping and impact monitoring activities have evolved to become more robust over the years and steered the LF elimination programme towards its goal. The findings showed that the WHO recommended mapping strategy aided 17 countries to delimit, plan and implement MDA in only those areas endemic for LF thereby saving resources. Availability of serological tools for detecting infection in humans (antigen/antibody assays) and molecular xenomonitoring (MX) in vectors greatly facilitated programme monitoring and evaluation in endemic countries. Results of this review are discussed on how these existing mapping and monitoring procedures can be used for re-mapping of unsurveyed and uncertain areas to ensure there is no resurgence during post-MDA surveillance. Further the appropriateness of the tests (Microfilaria (Mf)/antigenemia (Ag)/antibody(Ab) surveys in humans or MX of vectors for infection) used currently for post-MDA surveillance and their role in the development of a monitoring and evaluation strategy for the recently WHO recommended triple drug regimen in MDA for accelerated LF elimination are discussed.