Geospatial mapping of public sentiment and infodemic on human papillomavirus vaccination in India: An indication to formulation of strategies for effective implementation.

The implementation of Human Papillomavirus (HPV) vaccination is crucial for eliminating cervical cancer in India. The infodemic, characterised by misleading information, could hinder the successful implementation of the initiative. Misinformation related to the HPV vaccine, such as rumours, has been reported and circulated, contributing to an alarming pattern of vaccine hesitancy observed on social media. This study aimed to identify the public sentiment towards HPV vaccination based on the 'Behavioral and Social Drivers (BeSD)' framework through geospatial, content and sentiment analysis. A total of 1,487 tweets were extracted. After preprocessing, 1010 tweets were identified for sentiment and content analysis. The sentiments expressed towards the HPV vaccine are mixed, with a generally positive outlook on the vaccines. Within the population, there is a pervasive proliferation of misinformation, primarily focusing on vaccine safety and efficacy, contentious subjects, ethical considerations, and a prevalent sense of uncertainty in selecting the appropriate vaccine. These observations are crucial for developing targeted strategies to address public concerns and enhance vaccination rates. The insights gained from these results will guide policymakers, healthcare practitioners, and public health organisations to implement evidence-based interventions, thereby countering vaccine hesitancy and improving public health outcomes.

Scoping review of international relations theories in health security: A cue for health diplomacy.

Background: Health security as a domain has gained tremendous importance in the recent past. Emerging and re-emerging diseases globally, coupled with the derailment of the determinants of health mainly the socio-political environment, has made health security a cross-cutting entity in diverse fields including International Relations (IR). With the ongoing global polycrisis, the health-related issues which were previously sidelined as a concept of less strategic importance in the IR field, are now contributing to the shift of the world order. This has instilled an increased participation of IR scholars in the discussions and debates on health security concerns. The field of IR contains numerous theoretical lenses through which scholars analyze such situations, policies, and systems of the world. Methods: In this paper, we use a scoping review method to inspect how IR theories have been applied in analyzing health security concerns. Results: We observed that various diverging IR theories have been used to deliberate on states' actions in tackling the recent pandemic and have also been prescriptive about the changing notions of multilateralism and international governing organizations. Realism, liberalism, and securitization were among the most frequently applied IR theories in the context of health security discussions. Conclusions: This work provides an impetus to enhance the interaction among interdisciplinary teams leading to evolving solutions that can address issues of global importance in the contemporary world.

Interventions for Tobacco Prevention and Control in Humanitarian Settings: A Scoping Review.

INTRODUCTION: Tobacco usage is an epidemic as statistics point towards smoking as the second leading cause of death. Populations experiencing humanitarian emergencies may experience a higher propensity for tobacco, alcohol, and other substance abuse disorders. This review aimed to map tobacco prevention and control interventions in humanitarian settings. METHODS: The search for this scoping review was conducted in six databases and supplemented with a gray literature search. Articles were screened at title-abstract and full-text by two pairs of authors, and data was abstracted by three individuals independently. An adapted diffusion of governance framework is used to discuss the findings. RESULTS: A total of 26 articles were included from the searches conducted in the databases and grey literature. The interventions targeted all age groups. The documents retrieved from the grey literature search were classified as population-based interventions, as they were not restricted to a particular group of individuals. Interventions were delivered at various locations, using different methods and engaging multiple stakeholders. Interventions assessed were grouped into packaging, labeling, and other policy interventions (pricing and taxes). CONCLUSION: There are few tobacco prevention and control interventions in the humanitarian context. The diffusion of governance perspective in implementing these interventions in humanitarian settings provides a cue for inter-sectoral cooperation among different stakeholders and disciplines beyond the health sector. Our review recommends exploring complementarity between the demand and supply side interventions for tobacco control. IMPLICATIONS: The scoping review has highlighted various tobacco prevention and control efforts in humanitarian settings. The interventions were delivered using various modes, and yet the burden of smoking is higher among the humanitarian population. Further research may use impact evaluation techniques to assess the impact of these interventions to facilitate the re-design of the implementation approach and policy priorities.

A Scoping Review on Malaria Prevention and Control Intervention in Fragile and Conflict-Affected States (FCAS): A Need for Renewed Focus to Enhance International Cooperation.

Malaria is a major public health problem in developing countries. The burden of malaria in fragile and conflict-affected states (FCAS) is increasing year by year. Moreover, the population living in FCAS is often the most vulnerable and at high risk of malaria due to factors, such as deteriorating healthcare system, mass relocations, and reduced resilience to shocks. Therefore, this scoping review aims to map the interventions that are conducted at the FCAS on malaria prevention among the general population. In addition, this review can help policy-makers and international health bodies, providing a comprehensive overview that can lead to more targeted, effective, and context-specific interventions. Databases, such as PubMed, EBSCO-CINAHL, Web of Science, ProQuest, and Cochrane Central Register of Controlled Trials, were searched using specified search terms. A total of 3601 studies were retrieved from the search. After screening, 62 studies were included in the synthesis that met the eligibility criteria. Narrative analysis of the findings was done. The results revealed that in fragile countries, interventions for children below 5 years of age included IPTi, TDA, and ACT. In conflicted countries, interventions for children below 5 years of age included TDA, LLINs, SMC, drug trials, and vaccination. Similar interventions were reported for other age groups and populations. Despite ongoing conflicts, malaria interventions have been maintained in these countries, but a persistent high burden of malaria remains. To achieve the goals of malaria elimination, the results of the review highlight the need for continued research and evaluation of malaria control interventions to assess their effectiveness and impact. Strengthening health systems, building partnerships, utilizing digital health technologies, and conducting context-specific research are recommended to improve healthcare access and reduce the burden of malaria in FCAS.

Mapping capacity building programs in health diplomacy: Relevance and application in an uncertain world.

Background: Health diplomacy is one of the emerging avenues for academics where foreign policy dynamics and global health meet. Its relevance has augmented especially after the COVID-19 pandemic that brought the world to a halt. International organization and national entities that are responsible for health governance as well as its socio-economic determinants have been increasingly involved in the negotiations for a collective action towards a better health infrastructure and preparedness. However, the approach to health diplomacy seems to vary with whether health is looked through diplomacy lens or vice versa. Thus, inculcating adequate and appropriate competencies of both fields to conduct negotiations for health while keeping national interests and international commitments intact is imperative. Methods: This study investigates 50 programmes/courses that have been currently offered around the globe to understand the competencies that have been identified as essential for a health diplomat. We examined four aspects: i) geographical distribution of programme/course (ii) the type of global health diplomacy programme being offered and their duration (iii) mode of teaching and (iv) cross-cutting themes that the programme offers. Results: We found that the courses/programmes have been mostly provided by the countries of the Global North who play a key part in international negotiations. Although there were diverse types of certifications identified, they can be classified into two groups - core health diplomacy and inclusive health diplomacy programmes. The health diplomacy training is preferred to be provided in-person due to the nature of the work. Conclusions: While competencies for health governance and international relation have been dominant among the current programmes, other cross-cutting themes such as economics, politics, law, public policy, crisis management, environment and public health have been considered essential. The article concludes with a proposal of a framework to streamline the sectors and the competencies that is required in health diplomats.

Access to medicines through global health diplomacy.

The World Health Organisation (WHO) emphasizes that equitable access to safe and affordable medicines is vital to attaining the highest possible standard of health by all. Ensuring equitable access to medicines (ATM) is also a key narrative of the Sustainable Development Goals (SDGs), as SDG 3.8 specifies "access to safe, effective, quality and affordable essential medicines and vaccines for all" as a central component of universal health coverage (UHC). The SDG 3.b emphasizes the need to develop medicines to address persistent treatment gaps. However, around 2 billion people globally have no access to essential medicines, particularly in lower- and middle-income countries. The states' recognition of health as a human right obligates them to ensure access to timely, acceptable, affordable health care. While ATM is inherent in minimizing the treatment gaps, global health diplomacy (GHD) contributes to addressing these gaps and fulfilling the state's embracement of health as a human right.

Factors Influencing Monkeypox Vaccination: A Cue to Policy Implementation.

BACKGROUND: Following the mpox 2022 outbreak, several high-income countries have developed plans with inclusion criteria for vaccination against the mpox disease. This study was carried out to map the factors influencing mpox vaccination uptake to help address the challenges and increase vaccination confidence. METHODS: This was a study based on Tweet analysis. The VADER, Text Blob, and Flair analyzers were adopted for sentiment analysis. The "Levesque conceptual framework for healthcare access" was adopted to evaluate the factors impacting access and the decision to get mpox vaccination. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria were adopted. FINDINGS: A total of 149,133 tweets were extracted between 01/05/2022 and 23/09/2022. Around 1% of the random tweets were used for qualitative analysis. Of the 149,113, tweets were classified as positive, negative and neutral, respectively, by (a) VADER: (55,040) 37.05%, (44,395) 29.89%, and (49,106) 33.06%, (b) TextBlob: (70,900) 47.73%, (22,729) 15.30%, and (54,921) 36.97%, and (c) Flair: (31,389) 21.13%, (117,152) 78.87%, and 0.00%. Sentiment trajectories revealed that communication, stigmatization, accessibility to and availability of vaccines, and concerns about vaccine safety as factors influencing decision-making in the content and flow of tweets. INTERPRETATION: Twitter is a key surveillance tool for understanding factors influencing decisions and access to mpox vaccination. To address vaccine mistrust and disinformation, a social media-based risk communication plan must be devised. Adopting measures to remove logistical vaccination hurdles is needed. Obtaining fact-based information from credible sources is key to improving public confidence.

A sentiment and content analysis of tweets on monkeypox stigma among the LGBTQ+ community: A cue to risk communication plan.

Background: The stigma associated with monkeypox (mpox) may prevent people from following recommended guidelines. Using a "model of stigma communication," this study maps and determines the mpox stigma on Twitter among LGBTQ+ (Lesbian, gay, bisexual, transgender, queer and more) community. Methods: The tweets that contained the terms '#monkeypox', '#MPVS', '#stigma', and '#LGBTQ+' and were published between May 01, 2022 and Sept 07, 2022 were extracted. For sentiment analysis, the VADER, Text Blob, and Flair analysers were implemented. This study evaluated the dynamics of stigma communication based on the "model of stigma communication". A total of 70,832 tweets were extracted, from which 66,387 tweets were passed to the sentiment analyser and 3100 tweets were randomly selected for manual coding. Consolidated Criteria for Reporting Qualitative Research (COREQ) criteria was adopted to report this study. Findings: This research provided insight on the cause, communication, and patterns of mpox stigma in the LGBTQ+ community. In the community, stigmatisation was influenced by the group's labelling as the source of monkeypox. Some users believed that mpox resembled previously observed diseases such as HIV/AIDS, and COVID-19. Despite officials and media outlets disseminating information about preventing mpox and stigmatisation, a number of individuals failed to comply. The LGBTQ+ community faced peril in the form of violence due to escalating stigma. Misinformation and misinterpretation spread further stigmatisation. Interpretation: This study indicates that authorities must address misinformation, stigmatization of the LGBTQ+ community, and the absence of a comprehensive risk-communication plan to improve the system. The effects of stigmatization on the vulnerable population must be handled in conjunction with a well-developed risk communication plan, without jeopardizing their wellbeing.

A Comparative Analysis on the Social Determinants of COVID-19 Vaccination Coverage in Fragile and Conflict Affected Settings and Non-fragile and Conflict Affected Settings.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has coerced various resources of all the countries. While the high-income nations redirected financial and human resources to understand specific determinants of vaccination coverage, fragile and conflict-affected setting (FCS) nations were waiting for global bodies to cater to their ever-growing need for vaccines and other lifesaving drugs. This study aimed to determine various factors influencing vaccine coverage in the FCS context. METHODS: World Bank's classification of FCS states was the primary source for country classification. The study utilized data from various other open sources. The study models cross-country inequities in COVID-19 vaccine coverage and we have employed multi-variate log-linear regressions to understand the relationship between COVID-19 vaccine coverage and cross-country macro-level determinants. The analysis was conducted on two samples, non-FCS Countries and the FCS countries. RESULTS: Socio-economic determinants such as gross domestic product (GDP) per capita, socioeconomic resilience; health system determinants such as density of human resources, government spending on health expenditure; and political determinants such as effective government, more power to regional governments, political stability and absence of violence play a pivotal role in vaccine coverage. We also found that FCS countries with a higher share of people strongly believing in the vaccine effectiveness have a positive association with COVID-19 vaccine coverage. CONCLUSION: The study confirmed that political factors, government effectiveness and political stability are also important determinants of vaccine coverage. The result further draws attention to few policy implications such as promoting future research to explore the linkages between the perceived equality before the law and individual liberty and its effect on vaccination coverage in the FCS.

The rise of India's global health diplomacy amid COVID-19 pandemic.

The COVID-19 pandemic has highlighted the importance of global health diplomacy (GHD), with India emerging as a key player. India's commitment to GHD is demonstrated by its active participation in regional and multilateral projects, pharmaceutical expertise, and large-scale manufacturing capabilities, which include the production and distribution of COVID-19 vaccines and essential medicines. India has supported nations in need through bilateral and multilateral platforms, providing vaccines to countries experiencing shortages and offering technical assistance and capacity-building programs to improve healthcare infrastructure and response capabilities. India's unique approach to GHD, rooted in humanitarian diplomacy, emphasized collaboration and empathy and stressed the well-being of humanity by embracing the philosophy of "Vasudhaiva Kutumbakam," which translates to "the world is one family." Against this background, this paper's main focus is to analyze the rise of India's GHD amidst the COVID-19 pandemic and its leadership in addressing various global challenges. India has demonstrated its commitment to global solidarity by offering medical supplies, equipment, and expertise to more than 100 countries. India's rising global leadership can be attributed to its proactive approach, humanitarian diplomacy, and significant contributions to global health initiatives.

Rapid review on monkeypox policies among the G20 nations: relevance to policy and practitioner.

Background: Monkeypox has been declared as a Public Health Emergency of International Concern (PHEIC) by the WHO Director General (WHO-DG). Most of the G20 nations have reported Monkeypox outbreak. Policies developed and implemented in G20 countries for the prevention and control of monkeypox preparedness and response have global consequences. This rapid review aimed to map the monkeypox prevention and control policies planned and implemented in G20 nations in line with temporary recommendations issued by the WHO-DG. Methods: We mapped monkeypox prevention and control policies in G20 nations based on the WHO-DG recommendations. Medline (through PubMed), Scopus, and ProQuest Health and Medical Complete were searched to understand G20 preventative, diagnostic, and therapeutic policies. We also performed an extensive gray literature search through the Ministry of Health websites and newspaper through Google.  The documents/ studies that had an information on prevention, control and management guidelines/policies and published through journal, news articles and health ministry websites of G20 nations on monkeypox were included. We excluded the editorials, opinion, and perspective papers and studies published prior to May 6, 2022. Results: We obtained 671 articles with 10 articles included in the review. Additionally, we identified 55 documents from the gray literature. We included national guidelines of the 18 countries on the control, prevention, and management of monkeypox. National guidelines were compared with the WHO guidelines in terms of implementing coordinated response, engaging and protecting communities, surveillance and public health measures and international travel, clinical management and infection, prevention and control (IPC) measures and medical countermeasures research. Depending on the availability of resources, some recommendations are followed by nations while others are not. Conclusions: Coordinated response among states is key to contain the transmission of monkeypox. To bring a coordinated response, G20 nations are following temporary recommendations that are context specific to their nation.

Factors explaining men's intentions to support their partner's participation in cervical cancer screening.

BACKGROUND: Cervical cancer represents a high burden of disease. Many women in low- and middle-income countries face opposition from their partners and families to undergo cervical cancer screening. Identifying the social, cultural, and psychological factors that underly the opposition to screening by male partners is an important step towards reducing barriers for men to support their wives' participation in cervical screening. This study explored the role of structural and psychological factors deriving from theoretical models as determinants of Indian men's opposition to their partners being screened for cervical cancer. METHODS: A survey among 500 sexually active males was conducted between April 2020 and August 2020 to measure knowledge of cervical cancer and screening, awareness of screening possibilities, attitude towards screening, perceived barriers to screening, and health literacy. Regression analysis was performed to assess which of the potential factors contributed to the intention to support their wives' screening. RESULTS: The majority of participants had very poor knowledge and awareness about cervical cancer and screening procedures, tended towards a negative attitude towards screening, and perceived several structural barriers. Attitude towards the screening procedure and routine participation in general screening significantly predicted their intention to support their wives' screening for cervical cancer. Education moderated the association between knowledge and awareness and the intention to support their wives' screening. CONCLUSION: As women often rely on their spouses' financial and emotional support of cervical screening, there is a need for men to be encouraged to support their wives' screening participation. Programs to encourage men to support their wives' cervical screening should focus on their attitude towards screening, educate about cervical cancer and screening procedures, and reduce perceived barriers.

Tobacco prevention and control interventions in humanitarian settings: a scoping review protocol.

INTRODUCTION: Tobacco has been a complex global problem that has adversely affected almost all the sectors of society. However, the ill-effects are often most reflected in humanitarian settings, which inadvertently are surmounted by fragile systems. We aim to map tobacco prevention and control intervention in humanitarian settings. METHODS AND ANALYSIS: This scoping review will follow the guidelines of the Joanna Briggs Institute. A comprehensive search strategy was designed using Medical Subject Heading terms, subject experts and pertinent reviews. The search was conducted on Medline (through PubMed and Ovid), EMBASE (through OVID), ProQuest Health and Medical Complete, EBSCO (through CINAHL Complete), Scopus and Web of Science databases. Two reviewers will independently screen the identified studies on removing duplicates, which shall be followed by data extraction using a pretested data extraction form. A narrative synthesis approach will be employed to collate the findings from the studies and tabular formats would be used to aid the representation. ETHICS AND DISSEMINATION: This review will identify, map and synthesise the interventions for tobacco prevention and control in the humanitarian settings. An ethics committee approval was not sought for this body of work as it does not include human subjects. Results from the study will be disseminated through conference presentations and peer-reviewed publications.

A comparison of behavioural models explaining cervical cancer screening uptake.

BACKGROUND: Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention. METHODS: A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models. RESULTS: CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers. CONCLUSION: Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women's screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.

Cervical cancer screening status and implementation challenges: Report from selected states of India.

BACKGROUND: Cervical cancer contributes to 6%-29% of the cancers in India. Although the Government of India in 2010 integrated cancer screening within the National Programme for the prevention of Non-communicable Diseases, only 22% of women aged 15-45 years had undergone examination of the cervix by 2016. This prompts the question regarding the organisation of the program's implementation and service delivery and regarding challenges that may explain poor screening uptake. METHODS: Semi-structured interviews were held with program managers and implementers in seven districts of three selected States of India. The data analysis looked at program content, the organisation of screening delivery, and the challenges to the implementation of the program, considering six theoretically derived dimensions of public health capacity: leadership and governance, organisational structure, financial resources, workforce, partnerships, and knowledge development. RESULTS: Participants perceive the existing capacities across the six domains as insufficient to implement the CCS program nationwide. A context specific implementation, a better coordination between the program and district health facilities, timely remuneration, better maintenance of data and a strong monitoring system are possible solutions to remove health system related barriers. CONCLUSION: The study provides evidence on the practical challenges and provides recommendations for strengthening the capacities of the health system.

The application of health behavior theories to promote cervical cancer screening uptake.

BACKGROUND: While cervical cancer is a major cause of mortality, its progress and survival rate can be improved through screening. Yet despite their wide availability, women's participation in cervical cancer screening (CCS) programs is often suboptimal, especially in low- and middle-income countries. Besides demographic and organizational characteristics, screening uptake is influenced by psychological factors, most of which are included in health behavior theories. This systematic review compared different health behavior theories in terms of their capacity to explain CCS uptake and inform CCS promotion campaigns. METHODS: A comprehensive search and analysis of published intervention and non-intervention (observational) studies that applied at least one health behavior theory to CCS participation. RESULTS: After quality screening, 48 observational and 21 intervention studies were identified that applied the Health Belief Model (HBM), Theory of Reasoned Action (TRA), Theory of Planned Behaviour (TPB), Transtheoretical model (TTM), Social-ecological Model (SEM), and/or Theory of Triadic Influence (TTI) to CCS. The HBM was most frequently used to explain behavior, whereas the TPB was better at explaining screening intentions. Tailored intervention studies focusing on all theoretical constructs were most effective in modifying perceptions and increasing CCS uptake. CONCLUSIONS: Despite their inconsistent use, health behavior theories can explain CCS intentions and behavior and contribute to the development of targeted interventions to promote screening uptake.

Challenges and prospects in india's digital health journey.

India's journey in the digital health arena and its contribution to the landmark resolution on digital health by the World Health Organization has been recognized globally. India has demonstrated its commitment to leverage digital health as a health system strengthening intervention, as outlined in the National Digital Health Blueprint based on which, the National Digital Health Mission (NDHM) is currently being piloted by the National health authority. Further, the Sandbox environment of NDHM is actively encouraging all the ecosystem partners to familiarize with the evolving national digital health infrastructure. The strategy to enhance the India's progress in implementation and scale-up of digital health interventions are drawing attention to workforce capacity building, harnessing health data to facilitate research and development, evidence-informed development of policies, sustaining efficiency and quality of system through appropriate monitoring, and periodic evaluation informed by frameworks specific to digital health or those adapted to evaluate health informatics applications.

Cervical cytology and associated factors among tribal women of Karnataka, India.

BACKGROUND: Reproductive well-being is a crucial element of women's health. Due to the asymptomatic nature of gynaecological morbidities, women rarely seek medical advice in the initial period leading to delayed diagnosis and poor prognosis of subsequent disease. The present study aimed to explore the cervical cytology and its associated risk factors among women from tribal communities of the southern part of coastal Karnataka, India. METHODS: Papanicolaou (Pap) smear test was performed among 1140 women from three tribal populations, to detect cervical lesions, infections and reactive changes. A semi-structured questionnaire was administered to collect data on socio-demographic and reproductive characteristics of the study population. RESULTS: The most predominant gynaecological complaint among the participants was severe lower back ache (77.6%), followed by white discharge per vagina (29.0%) and menstrual irregularities (25.9%). Of the 1140 women screened, 12.4% showed cervical microbial infections, 23.6% were reported to have reactive changes, and 0.2% had epithelial cell abnormalities in the cervix. Cervical microbial infections were found to be associated with younger age group, low socio-economic status and younger age at sexual debut. CONCLUSION: Most of the symptoms suggestive of gynaecological morbidities reported in this study are preventable or treatable. Strengthening ongoing cervical cancer screening programme and implementation of health education programmes among tribal population would be the right policy approach to prevent, detect and treat these symptoms at an early stage and to achieve acceptable health outcomes among tribal women.