Comparative analysis of antibody responses to BNT162b2, ChAdOx1, and CoronaVac vaccines in the Albanian population over the pandemic years 2021 to 2022.

This repeated cross-sectional study with two independent sample populations compared the antibody response to severe acute respiratory syndrome coronavirus 2 vaccines in Albania in July-August 2021 and 2022. In 2021, it found higher anti-spike-1 seropositivity and antibody levels in fully vaccinated individuals, especially with BNT162b2 and ChAdOx1 and to a lesser degree with CoronaVac. By 2022, all single-dose recipients showed high antibody responses, suggesting natural infection-enhanced immunity. The study indicates a significant evolution in the antibody response to different coronavirus disease 2019 vaccines and suggests that a single vaccine dose, coupled with natural infection, might suffice to maintain adequate immunity levels in an endemic scenario.

Trends in SARS-CoV-2 seroprevalence in Albania during the 2021-2022 pandemic year.

Background: Monitoring SARS-CoV-2 seroprevalence dynamics during the COVID-19 pandemic is crucial for understanding population immunity and providing insights into public health policies. Limited data exist on this from Albania and other Eastern European countries. This study aimed to investigate SARS-CoV-2 seroprevalence in Albania, comparing August 2021 and August 2022 data from two representative samples of the general population. The objective was to understand the temporal dynamics of SARS-CoV-2 antibodies across age groups and assess the impacts of natural infection and vaccination on population immunity. Methods: This longitudinal study was conducted in two consecutive cross-sectional assessments 12 months apart in Albania's urban all-ages population. IgG anti-Spike-1 and anti-Nucleoprotein SARS-CoV-2 antibodies were measured using ELISA, focusing on seropositivity rates and antibody levels. Methods: The study encompassed 2143 and 2183 individuals in August 2021 and 2022, respectively, with the anti-S1-IgG seropositivity rate escalating from 70.9 â€‹% to 92.1 â€‹%. In 2021, seroprevalence ranged from 49.6 â€‹% (0-15 years) to 82 â€‹% (>60 years). By August 2022, it surpassed 90 â€‹% in most age groups, except 0-15 years (73.8 â€‹%). "Hybrid" immunity (COVID-19+ and Vaccine+) reached 56.6 â€‹% in 2022, or 2.8 times higher than in 2021, exhibiting the highest antibody levels compared to the only vaccinated or previously COVID-19-infected individuals. Conclusion: This study highlights an overall 94 % seroprevalence in the Albanian population in August 2022 and robust "hybrid" immunity, suggesting substantial protective immunity against SARS-CoV-2. The lower immunity in the 0-15 age group underscores the necessity for youth-targeted vaccine campaigns. These findings provide valuable insights for shaping healthcare measures and vaccination policies.

Update on HPV Vaccination Policies and Practices in 17 Eastern European and Central Asian Countries and Territories.

BACKGROUND: In 2021, a survey was conducted as part of the regional program of the United Nations Population Fund (UNFPA) Regional Office for Eastern Europe and Central Asia (EECA) to assess the policies and practices relating to HPV vaccination and cervical cancer screening in the 17 countries and territories included in this region. Since then, very substantial progress has been made with HPV vaccination across the region so another survey was conducted establish the current situation. METHODS: A 10 question survey covering the policies, plans and practices for HPV vaccination was prepared. As cervical cancer prevention is a priority for the UNFPA, its offices in the 17 countries and territories included in this study are well placed to identify the people who can provide authoritative data for this survey. Working with the UNFPA offices, the questionnaires were sent to these national experts in May 2023, with data collected until 30 June 2023. All countries and territories returned completed questionnaires. RESULTS: In the period from 30 June 2021 to 30 June 2023, the number of countries and territories that have implemented or are implementing HPV vaccination programs has doubled. As of 30 June 2021, only 6 of 17 countries and territories had implemented national HPV vaccination programmes, and by 30 June 2023, another 6 could be added to this list. Of the 4 countries with sub-optimal vaccination coverage rates in 2021, none showed substantial improvement over the 2-year period. CONCLUSIONS: The implementation of HPV vaccination programs across the region is progressing very rapidly with ≈70% of the countries and territories implementing or having implemented national programs. However, greater attention needs to be given to ensuring that both the old and the new programs will achieve high coverage rates.

Rapid increase of SARS-CoV-2 seroprevalence during the second half of the COVID-19 pandemic year 2020 in the adult urban Albanian population.

Background: This study aims to assess the changes in COVID-19 seroprevalence among the adult urban population of Albania between July and December 2020, when the Wuhan strain of SARS-CoV-2 virus was still prevalent in the country. Methods: Two independent, randomly selected samples of individuals aged 20-70 years residing in Metropolitan Tirana, Albania, were collected in June-July and December 2020. ELISA method was used for serological testing to determine IgG antibodies anti-S1-SARS-CoV-2. Results: The proportion of individuals classified as seropositive in early July was 7.5% (95% CI: 4.3%-10.7%), which increased 6.5 times in late December 2020, reaching 48.2% (95% CI: 44.8%-51.7%). The increasing seroprevalence rates in the study mirrored the trend of detected COVID-19 cases from June to December 2020 in Albania. However, they demonstrate a much higher cumulative incidence of the SARS-COV-2 infection in the community than the reported COVID-19 cases. Conclusion: The rapid increase in SARS-CoV-2 seroprevalence observed in Tirana City by the end of 2020 was likely a result of several factors, including the very low infection exposure between March-May 2020 when the entire city was in a lockdown, followed by the high susceptibility of the population due to naïve immunity. Despite the high observed seroprevalence at the end of December 2020, COVID-19 incidence continued to increase in Albania through 2021 and 2022 following the new virus variant surges.

HPV Vaccination and Cervical Cancer Screening Policies and Practices in 18 Countries, Territories and Entities across Eastern Europe and Central Asia.

BACKGROUND: To assess readiness to achieve the WHO Global Strategy targets for HPV vaccination and cervical screening and to guide capacity building, the current status of these services in 18 Eastern European and Central Asian countries, territories and entities (CTEs) was evaluated. METHODS: In order to assess the current status of HPV vaccination and cervical cancer screening in these 18 CTEs, a 30 question survey tool was developed, covering: national policies, strategies and plans for cervical cancer prevention; status of cancer registration; status of HPV vaccination; and current practices for cervical cancer screening and treatment of precancerous lesions. As cervical cancer prevention comes within the mandate of the United Nations Fund for Population Development (UNFPA), the UNFPA offices in the 18 CTEs have regular contact with national experts who are directly involved in cervical cancer prevention actions and are well placed to provide the data required for this survey. Working through the UNFPA offices, the questionnaires were sent to these national experts in April 2021, with data collected from April to July 2021. All CTEs returned completed questionnaires. RESULTS: Only Armenia, Georgia, Moldova, North Macedonia, Turkmenistan and Uzbekistan have implemented national HPV vaccination programmes, with only the last 2 of these reaching the WHO target of 90% of girls fully vaccinated by age 15, while rates in the other 4 range from 8%-40%. Cervical screening is available in all CTEs but only Belarus and Turkmenistan have reached the WHO target of 70% of women screened once by age 35 and again by age 45, while rates elsewhere range from 2%-66%. Only Albania and Turkey follow the WHO recommendation to use a high-performance screening test, while the majority use cervical cytology as the main screening test and Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan use visual inspection. No CTEs currently operate systems to coordinate, monitor and quality assure (QA) the entire cervical screening process. CONCLUSIONS: Cervical cancer prevention services in this region are very limited. Achieving the WHO Global Strategy targets by 2030 will require substantial investments in capacity building by international development organisations.

COVID-19 excess deaths in Eastern European countries associated with weaker regulation implementation and lower vaccination coverage.

Background: Since winter 2020, excess deaths due to COVID-19 have been higher in Eastern Europe than most of Western Europe, partly because regulatory enforcement was poor. Methods: This paper analysed data from 50 countries in the WHO European Region, in addition to data from USA and Canada. Excess mMortality and vaccination data were retrieved from "Our World In Data" and regulation implementation was assessed using standard methods. Multiple linear regression was used to assess the association between mortality and each covariate. Results: Excess mortality increased by 4.1 per 100 000 (P = 0.038) for every percentage decrease in vaccination rate and with 6/100 000 (p=0.011) for every decreased unit in the regulatory implementation score a country achieved in the Rule of Law Index. Conclusion: Degree of regulation enforcement, likely including public health measure enforcement, may be an important factor in controlling COVID-19's deleterious health impacts.

May Measurement Month 2019: an analysis of blood pressure screening results from Albania.

This article discusses the results of the May Measurement Month (MMM) 2019 campaign, which contributed to a third round of MMM hypertension screening campaigns carried out in Albania, a transitional country in the Western Balkans. The hypertension screening campaign in Albania was carried out during the period 1-31 May 2019 in 30 sites in many districts of the country. Overall, 19 154 participants aged ≥18 years were included (approximately 68% of these were women), with an overall mean age of 47.0 ± 15.3 years. Blood pressure (BP) was measured with OMRON sphygmomanometers (Omron Healthcare, Kyoto, Japan). Hypertension was defined as systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg, or on treatment for hypertension. Self-reported data consisted of height and weight, pre-existing conditions, including smoking status and alcohol consumption. Overall, the proportion of participants with hypertension was 38.6%. Less than two-thirds (64.7%) of hypertensive individuals were aware of their condition. Also, less than half (48.3%) of participants on antihypertensive medication had controlled BP (<140/90 mmHg). The most sizable correlations of high BP were with known hypertension status, use of antihypertensive medication, and obesity. The MMM campaign contributes to routine hypertension screening in Albania. Hence, health professionals and policymakers in Albania should act on the findings of MMM screening campaigns and continue its support as a valuable tool for early detection of hypertension in the general population.

Prevalence and sociodemographic correlates of medication intake adherence among primary health-care users in Albania.

BACKGROUND: Evidence about the magnitude and determinants of medication intake adherence among patients and the general population in Southeastern Europe is scant. AIMS: To assess the prevalence and sociodemographic correlates of medication intake adherence among adult primary health-care (PHC) users in Albania. METHODS: A cross-sectional study was conducted in 2018-2019 in a representative sample of 1553 adult PHC users (response: 94%) selected probabilistically from 5 major regions of Albania. There were 849 (55%) women and 704 (45%) men, with a mean age 54.6 (16.4) years. A structured interviewer-administered questionnaire inquired about medication intake adherence prescribed by family physicians, and sociodemographic characteristics. Binary logistic regression was used to assess the sociodemographic correlates of medication intake adherence. RESULTS: Three hundred (19.8%) participants did not take the prescribed medication. In multivariable-adjusted logistic model, significant correlates of nonintake of medication included rural residence, low educational level, unemployment and low economic level. Among these 300 participants, 273 (91%) considered the high cost of the drugs as a reason for not taking the medication. CONCLUSION: We found a high prevalence of nonintake of medication prescribed by family physicians. Decision-makers and policy-makers in Albania and elsewhere should consider the provision of essential drugs free of charge or at low cost to low socioeconomic groups and other vulnerable and marginalized population categories, because the costs of noncompliance will eventually be higher.

Promoting a Culture of Prevention in Albania: the "Si Je?" Program.

Albania is a small country on the Balkan Peninsula that recently implemented an innovative primary healthcare program called "Si Je?" (How are you?) which allowed all Albanians aged 40-65 years to receive a free, yearly basic health examination at their local health center. Access to basic primary care is a critical component of a nationwide culture of prevention particularly for the non-communicable diseases that comprise 89% of total deaths in the country. Yet, as in many middle-income countries, a culture of prevention in Albania is often secondary to ensuring basic health infrastructure and healthcare access for those critically in need. Using the social-ecological model as our conceptual framework, this paper provides new insights into the culture of prevention in Albania by analyzing the need for, and implementation of, the Si Je? program using (1) findings from a critical literature review, (2) quantitative data from the database created from this program, and (3) qualitative data from key informant interviews from 15 health center directors. Positive developments towards a culture of prevention include the fact that the Si Je? program has been expanded to those 35-70 years, strengthened links between community and primary care, and participation among rural communities who traditionally have limited primary care access. Challenges include continued urgent health infrastructure needs, politicization of the Si Je? effort, limited participation by some groups (particularly urban men), and regional variations. Despite challenges, Albania appears to be building new infrastructure for a sustainable culture of prevention, particularly around chronic disease.

The lower COVID-19 related mortality and incidence rates in Eastern European countries are associated with delayed start of community circulation.

BACKGROUND: The purpose of this analysis was to assess the variations in COVID-19 related mortality in relation to the time differences in the commencement of virus circulation and containment measures in the European Region. METHODS: The data for the current analysis (N = 50 countries) were retrieved from the John Hopkins University dataset on the 7th of May 2020, with countries as study units. A piecewise regression analysis was conducted with mortality and cumulative incidence rates introduced as dependent variables and time interval (days from the 22nd of January to the date when 100 first cases were reported) as the main predictor. The country average life expectancy at birth and outpatient contacts per person per year were statistically adjusted for in the regression model. RESULTS: Mortality and incidence were strongly and inversely intercorrelated with days from January 22, respectively -0.83 (p<0.001) and -0.73 (p<0.001). Adjusting for average life expectancy and outpatients contacts per person per year, between days 33 to 50 from the 22nd of the January, the average mortality rate decreased by 30.1/million per day (95% CI: 22.7, 37.6, p<0.001). During interval 51 to 73 days, the change in mortality was no longer statistically significant but still showed a decreasing trend. A similar relationship with time interval was found for incidence. Life expectancy and outpatients contacts per person per year were not associated with mortality rate. CONCLUSION: Countries in Europe that had the earliest COVID-19 circulation suffered the worst consequences in terms of health outcomes, specifically mortality. The drastic social isolation measures, quickly undertaken in response to those initial outbreaks appear effective, especially in Eastern European countries, where community circulation started after March 11th. The study demonstrates that efforts to delay the early spread of the virus may have saved an average 30 deaths daily per one million inhabitants.

May Measurement Month 2018: an analysis of blood pressure screening results from Albania.

This article reports on May Measurement Month (MMM) 2018, which consisted of the 2nd round of the hypertension screening campaign conducted in Albania, a former communist country in South Eastern Europe. The hypertension screening campaign in Albania was conducted during the period 13-31 May 2018. Overall, there were eight sites from seven districts of the country involving 7046 participants aged ≥18 years (61% women and 39% men; overall mean age 46.8 ± 15.7 years). Blood pressure was measured with OMRON sphygmomanometers (Omron Healthcare, Kyoto, Japan). Hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg, or diastolic blood pressure (DBP) ≥90 mmHg, or on treatment for hypertension. Self-reported information included height and weight, diabetes, smoking status, and alcohol intake. The proportion of participants with hypertension was 37.2% of whom only 52.1% exhibited awareness. Furthermore, only a quarter of hypertensive individuals were properly treated and controlled. Significant predictors of high SBP and/or high DBP included a previous diagnosis of hypertension, being on antihypertensive medication, frequent alcohol intake, and being overweight and obese. The MMM 2018 campaign in Albania had a unique value for early detection of hypertension, particularly among younger adults. Policymakers and decision-makers in Albania and elsewhere should also rely on the MMM screening campaigns which have a great potential for prevention and control of hypertension in the general population.

Understanding of Medication Information in Primary Health Care: A Cross-Sectional Study in a South Eastern European Population.

Aim: We aimed to assess adult primary health care (PHC) users' understanding of their medication information in a transitional South Eastern European population across seven domains. Methods: A cross-sectional study, carried out in Albania in 2018-19, included a representative sample of 1,553 PHC users aged ≥18 years (55% women; overall mean age: 54.6 ± 16.4 years; overall response rate: 94%). Participants were asked about their understanding of information they received from their respective family physicians about prescribed medicines in terms of factors like cost, dosage, and side-effects. Socio-demographic data were also gathered. Binary logistic regression was employed to assess the socio-demographic predictors of information about medication use and administration. Results: Across different aspects of use and administration, 21-60% of participants did not understand their medications. Less understanding of medication use was particularly high among the poor and those with low education and among urban residents, irrespective of socioeconomic status. Conclusion: This study provides important evidence about the level and socio-demographic determinants on understanding of information about medication use and administration among adult PHC users in a transitional former communist country in South Eastern Europe. Policymakers should be aware of the joint role and interplay between health literacy (demand side) and information provision (supply side), which both significantly influence the understanding of medication use by the general population.

Assessing the relationship between multimorbidity and depression in older men and women: the International Mobility in Aging Study (IMIAS).

Objectives: Our study aims to assess whether multimorbidity is an independent risk factor for the development of depression in older adults living in Canada, Brazil, Colombia, and Albania and examines differences in incidence of depression regarding social and psychosocial characteristics.Methods: The longitudinal International Mobility Aging Study (IMIAS) collected information from adults between 65-74 years old. Depression was defined by a 16 or higher score assessed by the Centre for Epidemiological Studies Depression (CES-D) Scale. Multimorbidity was defined as having two or more chronic conditions, which were self-reported by participants using a list of eight physical chronic conditions. Poisson regression was performed to estimate the relative risk of depression in older adults with multimorbidity compared to those living with 0-1 chronic conditions, adjusting for sex, age, education, number of doctor visits, degree of assistance needed, social support, and smoking status. The analysis was stratified by study region (Canada; Latin America; Albania).Results: Crude and adjusted models showed no statistically significant associations between multimorbidity and the incidence of depression in any of the study regions, confirmed by sensitivity analyses. However, the incidence of depression varied across study region, confirmed by the intra-class correlation coefficient which indicated that 13% of variations in depression incidence were due to geographic differences.Conclusion: Multimorbidity does not appear to increase the risk of developing depression in older adults between 65-74. Higher rates of depression in Latin America and Albania (compared to Canada) may be attributed to lifecourse exposures to social and economic adversity in these regions.

Meeting Physical Activity Guidelines by Walking in Older Adults From Three Middle-Income Countries: A Cross-Sectional Analysis From the International Mobility in Aging Study.

Physical activity (PA) among older adults is understudied in middle-income countries. The authors examined the associations of factors across levels of the social ecological model (individual, interpersonal, organizational, and community) with older adults meeting guidelines of 150 min of moderate- to vigorous-intensity PA per week through walking in three middle-income countries: Albania (n = 387), Colombia (n = 404), and Brazil (n = 402). Using 2012 International Mobility in Aging Study data, multivariate logistic regression models identified the following significant associations with meeting PA guidelines through walking (a) individual level: depression (odds ratio [OR] = 0.62, 95% confidence interval, CI [0.45, 0.86]), being female (OR = 0.74, 95% CI [0.56, 0.998]), and high relative education (OR = 1.79, 95% CI [1.33, 2.41]) and (b) interpersonal level: high life partner (OR = 1.38, 95% CI [1.04, 1.83]) and friend social ties (OR = 1.39, 95% CI [1.05, 1.83]). While individual and interpersonal variables were associated with meeting PA guidelines, community-level social and environmental variables were not.

Data gaps in adolescent fertility surveillance in middle-income countries in Latin America and South Eastern Europe: Barriers to evidence-based health promotion.

Adolescent health is a major global priority. Yet, as recently described by the World Health Organization (WHO), increased recognition of the importance of adolescent health rarely transforms into action. One challenge is lack of data, particularly on adolescent fertility. Adolescent pregnancy and childbirth are widespread and affect lifetime health and social outcomes of women, men, and families. Other important components of adolescent fertility include abortion, miscarriage, and stillbirth. Access to reliable, consistently-collected data to understand the scope and complexity of adolescent fertility is critical for designing strong research, developing meaningful policies, building effective programs, and evaluating success in these domains. Vital surveillance data can be challenging to obtain in general, and particularly in low- and middle-income countries and other under-resourced settings (including rural and indigenous communities in high-income countries). Definitions also vary, making comparisons over time and across locations challenging. Informed by the Adolescence and Motherhood Research project in Brazil and considering relevance to the Southern Eastern European (SEE) context, this article focuses on challenges in surveillance data for adolescent fertility for middle-income countries. Specifically, we review the literature to: (1) discuss the importance of understanding adolescent fertility generally, and (2) highlight relevant challenges and complexity in collecting adolescent fertility data, then we (3) consider implications of data gaps on this topic for selected middle-income countries in Latin America and SEE, and (4) propose next steps to improve adolescent fertility data for evidence-based health promotion in the middle-income country context.

Social and community factors associated with hypertension awareness and control among older adults in Tirana, Albania.

Background: Determinants of hypertension diagnosis and/or awareness and control among older adults are understudied in Albania, a former communist country in South Eastern Europe, which is experiencing rapid demographic, socioeconomic and epidemiological transition. This paper examines the association of individual, interpersonal, organizational and community factors with hypertension awareness and control among older adults in Tirana, the Albanian capital. Methods: Using 2012 International Mobility in Aging Study data on older adults from Albania's capital city (n = 393) and the socioecological model as a conceptual framework, multinomial regression models identified factors associated with controlled, uncontrolled and undiagnosed hypertension. Results: For hypertension, 17.3% participants had none, 23.4% were controlled, 48.4% were uncontrolled and 10.9% were undiagnosed/unaware. Compared to those with controlled hypertension, in multivariable models, a high level of friend support was negatively associated with uncontrolled (OR: 0.4; 95% CI: 0.2-0.9) and undiagnosed (OR: 0.2; 95% CI: 0.1-0.6) hypertension. A high level of perceived neighbourhood safety was negatively associated with uncontrolled (OR: 0.6; 95% CI: 0.3-1.0) and undiagnosed (OR: 0.4; 95% CI: 0.2-1.0) hypertension. Compared to those with no hypertension, children's social support was positively associated with uncontrolled (OR: 2.2; 95% CI: 1.1-4.3) and undiagnosed (OR: 3.6; 95% CI: 1.3-9.6) hypertension. Conclusion: This study provides new insights about distinct risk factors for inadequate hypertension management in Albania. It highlights the importance of community-level factors (safety) and interpersonal factors (family and friend ties) to hypertension diagnosis/awareness and control, which may provide novel intervention opportunities for hypertension programs.

Factors Associated With Visual Impairment and Eye Care Utilization: The International Mobility in Aging Study.

OBJECTIVE: To examine factors associated with visual impairment (VI) and eye care in the International Mobility in Aging Study (IMIAS). METHOD: IMIAS data were analyzed ( N = 1,995 with ages 65-74). Outcomes were VI defined as presenting visual acuity worse than 6/18 in the better eye and eye care utilization assessed by annual visits to eye care professionals. The Hurt-Insult-Threaten-Scream (HITS) questionnaire requested information on domestic violence. RESULTS: Among men, VI varied from 24% in Manizales (Colombia) to 0.5% in Kingston (Canada); among women, VI ranged from 20% in Manizales to 1% in Kingston; lifetime exposure to domestic violence was associated with VI (odds ratio [OR] = 1.87; 95% confidence interval [CI] = [1.17, 3.00]). Eye care utilization varied from 72% in Kingston's men to 25% in Tirana's men; it was associated with domestic violence (prevalence ratio [PR] = 1.3; 95% CI = [1.1, 1.6]). DISCUSSION: VI is more frequent where eye care utilization is low. Domestic violence may be a risk factor for VI.