ABSTRACT
Vaccine hesitancy among displaced populations is associated with inequitable access to services and mistrust of authorities, among other factors. This study evaluated variations in attitudes toward COVID-19 vaccines and factors associated with vaccine acceptance among refugees and Lebanese nationals accessing 60 International Medical Corps-supported health facilities through two cross-sectional surveys pre- (n = 3927; Survey 1) and post- (n = 4174; Survey 2) vaccine rollout. Logistic regression was used to assess predictors of vaccine acceptance using the health beliefs model. Refugees comprised 52.9% (Survey 1) and 54.2% (Survey 2) of respondents. Vaccine acceptance was low among both groups in Survey 1 (25.9% refugees vs. 23.1% Lebanese nationals), but higher in Survey 2 in Lebanese (57.6%) versus refugees (32.9%). Participants reported greater perceived benefits of vaccination, higher perceived COVID-19 susceptibility, and lower perceived vaccination barriers in Survey 2 versus Survey 1. Post-vaccine rollout, refugees had lower odds of vaccine acceptance compared to Lebanese (OR 0.50, 95%CI 0.41-0.60), while older age (OR 1.37, 95%CI 1.06-1.78, ≥51 years vs. 18-30 years) was associated with greater vaccine acceptance. Health beliefs model variables were associated with vaccine acceptance in both surveys. Tailored strategies to respond dynamically to changes in vaccine attitudes among vulnerable groups in Lebanon are essential for equitable vaccine uptake.
ABSTRACT
BACKGROUND: Research has been going on to formulate diagnostic criteria for TBM. Two criteria that have been studied and validated in high TB prevalence areas are the Youssef criteria (Rule 1) and Thwaites criteria (Rule 2). In our study we aimed to compare the different features of TBM and acute bacterial meningitis. METHODS: This retrospective study was done at Northwest General Hospital & Research Centre (NWGH&RC), Peshawar, Pakistan. Patients who were clinically diagnosed with TB meningitis or bacterial meningitis at the time of presentation were included in the study. RESULTS: Lab parameters for both groups were compared using independent sample T tests. We plotted ROC curves for Rule 1 and Rule 2. For Rule 1, at cut off value 2 it has a sensitivity of 97.5% and a specificity of 47.2%. For Rule 2, area at cut off value 3.5, sensitivity was 95% and specificity was 23.5%. We also plotted CSF protein to glucose ratio of our sample on an ROC curve and looked for measures of sensitivity and specificity. At cut off point 2 the sensitivity was 93% and specificity was 66.66%. CONCLUSION: It should be noted that although sensitivity for all three indices were high, specificity of all three tests was not very encouraging. We would like to emphasize that these indices can be useful in screening for patients with suspected TBM but they do not have the specificity to act as the sole test for initiation and continuance of therapy.