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1.
Ann Glob Health ; 88(1): 77, 2022.
Article in English | MEDLINE | ID: covidwho-2040272

ABSTRACT

Background: Migrant and seasonal farmworkers face enormous barriers to health and have been a particularly vulnerable population during the COVID-19 pandemic, but their pandemic experiences and potential inequities have not been well studied. Objectives: We aimed to assess the impact of COVID-19 in Immokalee, Florida, a community with a significant population of migrant and seasonal farmworkers. We evaluated for differences in pandemic experience by language, a known barrier to healthcare, to inform and strengthen future public health efforts. Methods: First, to estimate the burden of COVID in the area, we conducted a descriptive analysis of data on COVID-19 deaths for Collier County from May-August 2020. We then surveyed a cross-sectional, randomized representative sample of 318 adults living in Immokalee from March-November 2020 to assess socio-demographics, workplace conditions, sources of information, ability to follow guidelines, and experiences with testing and contact tracing programs. Results were compared across language groups. Findings: Average excess mortality in Collier County was 108%. The majority surveyed in Immokalee had socio-demographic factors associated with higher COVID risk. Non-English speakers had higher workplace risk due to less ability to work from home. Haitian Creole speakers were less likely to be tested, though all participants were willing to get symptomatic testing and quarantine. Those participants who tested positive or had COVID-19 exposures had low engagement with the contact tracing program, and Spanish-speakers reported lower quality of contact tracing than English speakers. Conclusions: The community of Immokalee, FL is a vulnerable population that suffered disproportionate deaths from COVID-19. This study reveals language inequities in COVID testing and contact tracing that should be targeted in future pandemic response in Immokalee and other migrant farmworker communities.


Subject(s)
COVID-19 , Transients and Migrants , Adult , COVID-19/epidemiology , COVID-19 Testing , Contact Tracing , Cross-Sectional Studies , Farmers , Florida/epidemiology , Haiti/epidemiology , Humans , Pandemics
2.
PLoS One ; 17(9): e0274760, 2022.
Article in English | MEDLINE | ID: covidwho-2039425

ABSTRACT

BACKGROUND: Haiti's first COVID-19 cases were confirmed on March 18, 2020, and subsequently spread throughout the country. The objective of this study was to describe clinical manifestations of COVID-19 in Haitian outpatients and to identify risk factors for severity of clinical manifestations. METHODS: We conducted a retrospective study of COVID-19 outpatients diagnosed from March 18-August 4, 2020, using demographic, epidemiological, and clinical data reported to the Ministry of Health (MoH). We used univariate and multivariate analysis, including multivariable logistic regression, to explore the risk factors and specific symptoms related to persons with symptomatic COVID-19 and the severity of symptomatic COVID-19 disease. RESULTS: Of 5,389 cases reported to MOH during the study period, 1,754 (32.5%) were asymptomatic. Amongst symptomatic persons 2,747 (75.6%) had mild COVID-19 and 888 (24.4%) had moderate-to-severe disease; the most common symptoms were fever (69.6%), cough (51.9%), and myalgia (45.8%). The odds of having moderate-to-severe disease were highest among persons with hypertension (aOR = 1.72, 95% Confidence Interval [CI] (1.34, 2.20), chronic pulmonary disease (aOR = 3.93, 95% CI (1.93, 8.17)) and tuberculosis (aOR = 3.44, 95% CI (1.35, 9.14)) compared to persons without those conditions. The odds of having moderate-to-severe disease increased with age but was also seen among children aged 0-4 years (OR: 1.73, 95% CI (0.93, 3.08)), when using 30-39 years old as the reference group. All of the older age groups, 50-64 years, 65-74 years, 75-84 years, and 85+ years, had significantly higher odds of having moderate-to-severe COVID-19 compared with ages 30-39 years. Diabetes was associated with elevated odds of moderate-to-severe disease in bivariate analysis (OR = 2.17, 95% CI (1.58,2.98) but, this association did not hold in multivariable analyses (aOR = 1.22,95%CI (0.86,1.72)). CONCLUSION: These findings from a resource-constrained country highlight the importance of surveillance systems to track emerging infections and their risk factors. In addition to co-morbidities described elsewhere, tuberculosis was a risk factor for moderate-to-severe COVID-19 disease.


Subject(s)
COVID-19 , Adult , Aged , COVID-19/epidemiology , Child , Haiti/epidemiology , Humans , Outpatients , Retrospective Studies , Risk Factors , SARS-CoV-2
3.
PLoS One ; 17(8): e0273482, 2022.
Article in English | MEDLINE | ID: covidwho-2021921

ABSTRACT

Few data are available on frequency of SARS-CoV-2 infection among very young children in low- to middle-income countries (LMIC), with the studies that are available biased towards higher income countries with low reported infection and seroconversion rates. Between February 2019 and March 2021, 388 dried blood spot (DBS) samples were obtained from 257 children less than 30 months of age as part of a prospective observational cohort study of pregnant women and their infants in Haiti; longitudinal samples were available for 107 children. In a subsequent retrospective analysis, DBS samples were tested by ELISA for antibody targeting the receptor binding domain of the SARS-CoV-2 S1 protein. Over the course of the study, 16·7% of the infants became seropositive. All seropositive samples were collected after March 19, 2020 (the date of the first reported COVID-19 case in Haiti) with the highest hazards measured in August 2020. Sampling date was the only covariate associated with the hazard of seroconversion. Our data provide an estimate of SARS-CoV-2 infection rates among very young children without prior SARS-CoV-2 exposure during the initial pandemic waves in Haiti, and demonstrate that these children mount a detectable serological response which is independent of patient age.


Subject(s)
COVID-19 , Antibodies, Viral , COVID-19/epidemiology , Child , Child, Preschool , Cohort Studies , Female , Haiti/epidemiology , Humans , Immunoglobulin G , Infant , Pregnancy , Prospective Studies , Retrospective Studies , SARS-CoV-2
4.
Int J Environ Res Public Health ; 19(16)2022 08 12.
Article in English | MEDLINE | ID: covidwho-1987771

ABSTRACT

This paper explores the migration experiences, perceived COVID-19 impacts, and depression symptoms among Haitian migrants living in Santiago, Chile. Ninety-five participants from eight neighborhoods with a high density of Haitian migrants were recruited. Descriptive statistics, univariate analysis, and logistic regression analysis were conducted. Chi-squared tests were used to confirm univariate results. We found that 22% of participants had major depressive symptoms based on the CESD-R-20 scale, 87% reported major life changes due to COVID-19, and 78% said their migration plans had changed due to the pandemic. Factors associated with more depressive symptoms were being in debt (OR = 3.43) and experiencing discrimination (ORs: 0.60 to 6.19). Factors associated with less odds of depressive symptoms were social support (ORs: 0.06 to 0.25), change in migration plans due to COVID-19 (OR = 0.30), and planning to leave Chile (OR = 0.20). After accounting for relevant factors, planning to leave Chile is significantly predictive of fewer symptoms of depression. Haitian migrants living in Chile had a high prevalence of depression. Planning to leave Chile was a significant protector against depressive symptoms. Future studies should explore how nuanced experiences of uncertainty play out in migrants' lives, mental well-being, and planning for their future.


Subject(s)
COVID-19 , Depressive Disorder, Major , Transients and Migrants , COVID-19/epidemiology , Chile/epidemiology , Depression/epidemiology , Haiti/epidemiology , Humans
6.
Med Trop Sante Int ; 1(1)2021 03 31.
Article in French | MEDLINE | ID: covidwho-1893749

ABSTRACT

SAt a time when the Covid-19 pandemic is wreaking havoc around the world, it is certainly useful to take a step back epidemiologically. Reading Renaud Piarroux's book on his experience of fighting the cholera epidemic in Haiti between 2010 and 2018 is rich in lessons. It shows the fiasco and the wanderings of the United Nations system and some of its executives, but also the narrow vision of French diplomats and global health officials. But the book is also valuable for understanding the academic functioning of global public health, in the image of the contemporary Covidian disaster: biomedical public health, oriented towards certain diseases in particular, without an interdisciplinary vision and with its share of excesses, abuse and scientific clientelism. Students and young researchers should be able to use this analysis to change the situation…in the hope that they will be given space.


Subject(s)
COVID-19 , Cholera , COVID-19/epidemiology , Cholera/epidemiology , Haiti/epidemiology , Humans , Pandemics , United Nations
7.
Hum Vaccin Immunother ; 18(5): 2050121, 2022 11 30.
Article in English | MEDLINE | ID: covidwho-1764460

ABSTRACT

COVID-19 vaccination is an effective intervention preventing individuals from contracting SARS-CoV-2 or transmitting the virus to others. However, in many countries, vaccine hesitancy has impeded the progress of mass vaccination to reach herd immunity. This study aimed to understand the similarities and differences in the determinants of COVID-19 vaccine hesitancy in Taiwan, the United States, the Netherlands, and Haiti. A qualitative study was conducted by face-to-face interviews with participants in Taiwan and remote online interviews with participants in the United States, the Netherlands, and Haiti. In total, 47 interviews were conducted. A reflective thematic analysis was employed to analyze the collected data. Distrust of COVID-19 vaccines was reported by the participants in all countries. A perception of a lack of necessity or urgency to be vaccinated was reported by the Taiwanese and Haitian participants. Lack of knowledge regarding COVID-19 vaccines was reported by the Taiwanese, U.S. and Haitian participants, contributing to hesitation or refusal to vaccination. Regarding misinformation and rumors, misinformation was found among a few Taiwanese and Dutch participants. Additionally, rumors concerning COVID-19 vaccines were mentioned by the Dutch and Haitian participants. Furthermore, a lack of verified information was reported by the participants in all four countries. Overall, the current study suggests that vaccine hesitancy exists among participants in Taiwan, the United States, the Netherlands, and Haiti. Building trust in the COVID-19 vaccine, cultivating vaccine literacy, clarifying misinformation and rumors concerning COVID-19 vaccines, and providing verified information are critical for increasing public acceptance of the COVID-19 vaccine.


Subject(s)
COVID-19 , Vaccines , COVID-19/prevention & control , COVID-19 Vaccines , Haiti/epidemiology , Humans , Netherlands , Patient Acceptance of Health Care , SARS-CoV-2 , Taiwan , Trust , United States , Vaccination , Vaccination Hesitancy
8.
Bull World Health Organ ; 100(2): 115-126C, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1760156

ABSTRACT

OBJECTIVE: To examine changes in vaccination of children younger than 1 year during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-August 2021) in Haiti, Lesotho, Liberia and Malawi. METHODS: We used data from health management information systems on vaccination of children aged 12 months or younger in districts supported by Partners In Health. We used data from January 2016 to February 2020 and a linear model with negative binomial distribution to estimate the expected immunization counts for March 2020-August 2021 with 95% prediction intervals, assuming no pandemic. We compared these expected levels with observed values and estimated the immunization deficits or excesses during the pandemic months. FINDINGS: Baseline vaccination counts varied substantially by country, with Lesotho having the lowest count and Haiti the highest. We observed declines in vaccination administration early in the COVID-19 pandemic in Haiti, Lesotho and Liberia. Continued declines largely corresponded to high rates of COVID-19 infection and discrete stock-outs. By August 2021, vaccination levels had returned to close to or above expected levels in Haiti, Liberia and Lesotho; in Malawi levels remained below expected. CONCLUSION: Patterns of childhood immunization coverage varied by country over the course of the pandemic, with significantly lower than expected vaccination levels seen in one country during subsequent COVID-19 waves. Governments and health-care stakeholders should monitor vaccine coverage closely and consider interventions, such as community outreach, to avoid or combat the disruptions in childhood vaccination.


Subject(s)
COVID-19 , Child , Haiti/epidemiology , Humans , Immunization , Immunization Programs , Infant , Lesotho/epidemiology , Liberia/epidemiology , Malawi/epidemiology , Pandemics , SARS-CoV-2 , Vaccination
9.
BMC Health Serv Res ; 22(1): 340, 2022 Mar 15.
Article in English | MEDLINE | ID: covidwho-1745458

ABSTRACT

BACKGROUND: Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective. METHODS: The conceptual framework designed is based on a combination of Levesque's Health Access Framework and the Foreign, Commonwealth and Development Office's Resilience Framework to address both outputs and the processes of resilience of healthcare systems. It uses a mixed-method sequential exploratory research design combining multi-sites and longitudinal approaches. Forty clusters spread over four sites will be studied to understand the importance of context, involving more than 40 healthcare service providers and 2000 households to be surveyed. We will collect primary data through questionnaires, in-depth and semi-structured interviews, focus groups and participatory filming. We will also use secondary data on environmental events sensitive to climate change and potential health risks, healthcare providers' functioning and organisation. Statistical analyses will include event-history analyses, development of composite indices, multilevel modelling and spatial analyses. DISCUSSION: This research will generate inter-disciplinary evidence and thus, through knowledge transfer activities, contribute to research on low and middle-income countries (LMIC) health systems and global changes and will better inform decision-makers and populations.


Subject(s)
COVID-19 , Research Design , Bangladesh/epidemiology , COVID-19/epidemiology , Delivery of Health Care , Haiti/epidemiology , Humans , Pandemics
10.
J Int Assoc Provid AIDS Care ; 21: 23259582221084536, 2022.
Article in English | MEDLINE | ID: covidwho-1731505

ABSTRACT

The Ryan White Program (RWP) in Miami-Dade County, Florida made several modifications to keep HIV care accessible during the COVID-19 Pandemic, including expanding telehealth services, increasing access to HIV medications, and waiving required lab tests for service recertification. We assessed ease of access to medical providers, medical case managers, and antiretroviral medications during the COVID-19 Pandemic among 298 Non-Hispanic Black, Hispanic, and Haitian people with HIV (PWH) served by the RWP Part A, Miami-Dade County, Florida using a telephone-administered survey between October 2020 and January 2021. Overall, most clients reported similar or better access compared to before the Pandemic. Use of videocalls to communicate with HIV medical providers varied by race/ethnicity: Hispanics (49.6%), Non-Hispanic Blacks (37.7%), and Haitian clients (16.0%). Results suggest the modifications helped maintain access to care during an unprecedented health crisis. Permanently adopting many of these modifications should be considered to continue to facilitate access to care.


Subject(s)
COVID-19 , HIV Infections , COVID-19/epidemiology , Ethnic and Racial Minorities , Ethnicity , Florida/epidemiology , HIV Infections/drug therapy , HIV Infections/epidemiology , Haiti/epidemiology , Humans , Minority Groups , Pandemics , SARS-CoV-2
11.
Clin Infect Dis ; 74(11): 2057-2060, 2022 06 10.
Article in English | MEDLINE | ID: covidwho-1700565

ABSTRACT

After an initial wave of coronavirus disease 2019 (COVID-19) in Haiti in summer 2020 (primarily lineage B.1), seropositivity for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) was ~40%. Variant P.1 (gamma) was introduced in February 2021, with an initially limited introduction followed by exponential local dissemination within this unvaccinated population with prior exposure to earlier SARS-CoV-2 lineages.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19 Testing , Haiti/epidemiology , Humans , SARS-CoV-2/genetics
12.
Nature ; 600(7887): 133-137, 2021 12.
Article in English | MEDLINE | ID: covidwho-1521757

ABSTRACT

Coronaviruses have caused three major epidemics since 2003, including the ongoing SARS-CoV-2 pandemic. In each case, the emergence of coronavirus in our species has been associated with zoonotic transmissions from animal reservoirs1,2, underscoring how prone such pathogens are to spill over and adapt to new species. Among the four recognized genera of the family Coronaviridae, human infections reported so far have been limited to alphacoronaviruses and betacoronaviruses3-5. Here we identify porcine deltacoronavirus strains in plasma samples of three Haitian children with acute undifferentiated febrile illness. Genomic and evolutionary analyses reveal that human infections were the result of at least two independent zoonoses of distinct viral lineages that acquired the same mutational signature in the genes encoding Nsp15 and the spike glycoprotein. In particular, structural analysis predicts that one of the changes in the spike S1 subunit, which contains the receptor-binding domain, may affect the flexibility of the protein and its binding to the host cell receptor. Our findings highlight the potential for evolutionary change and adaptation leading to human infections by coronaviruses outside of the previously recognized human-associated coronavirus groups, particularly in settings where there may be close human-animal contact.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Deltacoronavirus/isolation & purification , Swine/virology , Viral Zoonoses/epidemiology , Viral Zoonoses/virology , Amino Acid Sequence , Animals , Bayes Theorem , Child , Chlorocebus aethiops , Conserved Sequence , Coronavirus Infections/blood , Deltacoronavirus/classification , Deltacoronavirus/genetics , Deltacoronavirus/pathogenicity , Female , Haiti/epidemiology , Humans , Male , Models, Molecular , Mutation , Phylogeny , Vero Cells , Viral Zoonoses/blood
15.
J Public Health Manag Pract ; 26(5): 503-505, 2020.
Article in English | MEDLINE | ID: covidwho-1146362
16.
AIDS Behav ; 25(5): 1366-1372, 2021 May.
Article in English | MEDLINE | ID: covidwho-1141461

ABSTRACT

INTRODUCTION: Our study describes changes in HIV care service delivery and continuity of HIV antiretroviral therapy (ART) for people living with HIV (PLHIV) during the 8 weeks before and after diagnosis of the first coronavirus disease 2019 (COVID-19) cases in Haiti on March 19, 2020. METHODS: Using data from 96 out of 167 health facilities offering ART services, we compared four ART program indicators: (1) count of HIV visits; (2) proportion of ART dispenses in community-based settings (DAC); (3) proportion of multi-month dispensing of ART medications > 6 months (> 6 m MMD); and (4) proportion of timely ART refills. We used uncontrolled interrupted time series (ITS) models to estimate slope and level changes in each indicator with the arrival of COVID-19. RESULTS AND DISCUSSION: From week 1 to week 16, the average number of HIV visits fell from 121.5 to 92.5 visits, the proportion of DAC rose from 22.7% to 36.7%, the proportion of > 6 m MMD rose from 29.4% to 48.4%, and the proportion of timely ART refills fell from 51.9% to 43.8%. The ITS models estimated abrupt increases of 36% in > 6 m MMD (p < 0.001) and 37% in DAC (p < 0.001) at the time of COVID-19 arrival, and no change after arrival of COVID-19. The was an abrupt decline of 18% in timely ART refills with the arrival of COVID-19 and a decline of 1% per week thereafter, both non-statistically significant changes. CONCLUSIONS: The sudden changes in HIV service utilization represent dramatic adaptations needed to mitigate primary and secondary effects of the COVID-19 pandemic on PLHIV. This study underscores the urgency of optimizing ART delivery models in Haiti and beyond, in order to maintain progress toward HIV epidemic control.


Subject(s)
Anti-HIV Agents , COVID-19 , HIV Infections , Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/epidemiology , Haiti/epidemiology , Humans , Pandemics , SARS-CoV-2
17.
Psychiatry Res ; 297: 113714, 2021 03.
Article in English | MEDLINE | ID: covidwho-1033160

ABSTRACT

OBJECTIVES: Currently, there is little data on the mental health consequences of the COVID-19 pandemic in low- and middle-income countries (LMICs). This study aims to examine the pooled and separate prevalence and determinants of depression during the pandemic in samples from four LMICs. METHODS: Participants (N= 1267, 40.9% women) were recruited from the Democratic Republic of the Congo (DRC), Haiti, Rwanda, and Togo. They completed an online cross-sectional survey on sociodemographics, exposure and stigmatization related to COVID-19, the Hopkins Symptom Checklist depression subscale, and the Connor-Davidson Resilience Scale-2. RESULTS: The pooled prevalence for depression symptoms was 24.3% (95% CI: 22.08-26.79%), with significant differences across countries. Younger age, gender (women), and high levels of exposure and stigmatization related to COVIID-19, and resilience were associated with depression in the pooled data. There were significant variations at the country level. Stigmatization (but not exposure to COVID-19 and resilience) was a strong predictor among the four countries. CONCLUSIONS: The prevalence of depression symptoms in the LMICs are similar to those reported in China and in most high-income countries during the pandemic. The findings emphasize the need for implementing non-fear-based education programs during epidemics to reduce stigmatization.


Subject(s)
Anxiety/epidemiology , COVID-19/psychology , Depression/epidemiology , SARS-CoV-2 , Social Stigma , Adult , Anxiety/psychology , COVID-19/epidemiology , Cross-Sectional Studies , Democratic Republic of the Congo/epidemiology , Educational Status , Female , Haiti/epidemiology , Humans , Income , Male , Mental Health , Middle Aged , Pandemics , Poverty , Prevalence , Rwanda/epidemiology , Stereotyping , Togo , Young Adult
18.
Am J Trop Med Hyg ; 103(5): 1986-1988, 2020 11.
Article in English | MEDLINE | ID: covidwho-961767

ABSTRACT

The COVID-19 pandemic poses a unique threat to patients with multidrug-resistant tuberculosis (MDR-TB). We describe a case of a patient with pulmonary MDR-TB and COVID-19 in Port-au-Prince, Haiti, and highlight the challenges and approach to managing a patient with both diseases.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Tuberculosis, Multidrug-Resistant/complications , Tuberculosis, Multidrug-Resistant/epidemiology , Adult , COVID-19 , Haiti/epidemiology , Humans , Male , Pandemics , SARS-CoV-2
19.
BMC Public Health ; 20(1): 1853, 2020 Dec 03.
Article in English | MEDLINE | ID: covidwho-958032

ABSTRACT

BACKGROUND: In late January, a worldwide crisis known as COVID-19 was declared a Public Health Emergency of International Concern by the WHO. Within only a few weeks, the outbreak took on pandemic proportions, affecting over 100 countries. It was a significant issue to prevent and control COVID-19 on both national and global scales due to the dramatic increase in confirmed cases worldwide. Government guidelines provide a fundamental resource for communities, as they guide citizens on how to protect themselves against COVID-19, however, they also provide critical guidance for policy makers and healthcare professionals on how to take action to decrease the spread of COVID-19. We aimed to identify the differences and similarities between six different countries' (US, China, South Korea, UK, Brazil and Haiti) government-provided community and healthcare system guidelines, and to explore the relationship between guideline issue dates and the prevalence/incidence of COVID-19 cases. METHODS: To make these comparisons, this exploratory qualitative study used document analysis of government guidelines issued to the general public and to healthcare professionals. Documents were purposively sampled (N = 55) and analyzed using content analysis. RESULTS: The major differences in the evaluation and testing criteria in the guidelines across the six countries centered around the priority of testing for COVID-19 in the general population, which was strongly dependent on each country's healthcare capacity. However, the most similar guidelines pertained to the clinical signs and symptoms of COVID-19, and methods to prevent its contraction. CONCLUSION: In the initial stages of the outbreak, certain strategies were universally employed to control the deadly virus's spread, including quarantining the sick, contact tracing, and social distancing. However, each country dealt with differing healthcare capacities, risks, threats, political and socioeconomic challenges, and distinct healthcare systems and infrastructure. Acknowledging these differences highlights the importance of examining the various countries' response to the COVID-19 pandemic with a nuanced view, as each of these factors shaped the government guidelines distributed to each country's communities and healthcare systems.


Subject(s)
COVID-19/prevention & control , Government , Guidelines as Topic , Brazil/epidemiology , COVID-19/epidemiology , China/epidemiology , Haiti/epidemiology , Humans , Qualitative Research , Republic of Korea/epidemiology , United Kingdom/epidemiology , United States/epidemiology
20.
J Psychiatr Res ; 132: 13-17, 2021 01.
Article in English | MEDLINE | ID: covidwho-841616

ABSTRACT

OBJECTIVE: Studies have documented the significant direct and indirect psychological, social, and economic consequences of the Coronavirus disease 2019 (COVID-19) in many countries but little is known on its impact in low- and middle-income countries (LMICs) already facing difficult living conditions and having vulnerable health systems that create anxiety among the affected populations. Using a multinational convenience sample from four LMICs (DR Congo, Haiti, Rwanda, and Togo), this study aims to explore the prevalence of anxiety symptoms and associated risk and protective factors during the COVID-19 pandemic. METHODS: A total of 1267 individuals (40.8% of women) completed a questionnaire assessing exposure and stigmatization related to COVID-19, anxiety, and resilience. Analyses were performed to examine the prevalence and predictors of anxiety. RESULTS: Findings showed a pooled prevalence of 24.3% (9.4%, 29.2%, 28.5%, and 16.5% respectively for Togo, Haiti, RDC, and Rwanda, x2 = 32.6, p < .0001). For the pooled data, exposure to COVID-19 (ß = 0.06, p = .005), stigmatization related to COVID-19 (ß = 0.03, p < .001), and resilience (ß = -0.06, p < .001) contributed to the prediction of anxiety scores. Stigmatization related to COVID-19 was significantly associated to anxiety symptoms in all countries (ß = 0.02, p < .00; ß = 0.05, p = .013; ß = 0.03, p = .021; ß = 0.04, p < .001, respectively for the RDC, Rwanda, Haiti, and Togo). CONCLUSIONS: The findings highlight the need for health education programs in LMICs to decrease stigmatization and the related fears and anxieties, and increase observance of health instructions. Strength-based mental health programs based on cultural and contextual factors need to be developed to reinforce both individual and community resilience and to address the complexities of local eco-systems.


Subject(s)
Anxiety/epidemiology , COVID-19/epidemiology , Developing Countries/statistics & numerical data , Health Knowledge, Attitudes, Practice , Resilience, Psychological , Social Stigma , Adult , Anxiety/etiology , Congo/epidemiology , Female , Haiti/epidemiology , Humans , Male , Middle Aged , Prevalence , Protective Factors , Risk Factors , Rwanda/epidemiology , Togo/epidemiology
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