Exposure to urban green spaces and mental health during the COVID-19 pandemic: evidence from two low and lower-middle-income countries.

Introduction: The COVID-19 pandemic has had a significant impact on mental health globally, with limited access to mental health care affecting low- and middle-income countries (LMICs) the most. In response, alternative strategies to support mental health have been necessary, with access to green spaces being a potential solution. While studies have highlighted the role of green spaces in promoting mental health during pandemic lockdowns, few studies have focused on the role of green spaces in mental health recovery after lockdowns. This study investigated changes in green space access and associations with mental health recovery in Bangladesh and Egypt across the pandemic. Methods: An online survey was conducted between January and April 2021 after the first lockdown was lifted in Bangladesh (n = 556) and Egypt (n = 660). We evaluated indoor and outdoor greenery, including the number of household plants, window views, and duration of outdoor visits. The quantity of greenness was estimated using the normalized difference vegetation index (NDVI). This index was estimated using satellite images with a resolution of 10x10m during the survey period (January-April 2021) with Sentinel-2 satellite in the Google Earth Engine platform. We calculated averages within 250m, 300m, 500m and 1000m buffers of the survey check-in locations using ArcGIS 10.3. Multiple linear regression models were used to evaluate relationships between changes in natural exposure and changes in mental health. Results: The results showed that mental health improved in both countries after the lockdown period. People in both countries increased their time spent outdoors in green spaces after the lockdown period, and these increases in time outdoors were associated with improved mental health. Unexpectedly, changes in the number of indoor plants after the lockdown period were associated with contrasting mental health outcomes; more plants translated to increased anxiety and decreased depression. Refocusing lives after the pandemic on areas other than maintaining indoor plants may assist with worrying and feeling panicked. Still, indoor plants may assist with depressive symptoms for people remaining isolated. Conclusion: These findings have important implications for policymakers and urban planners in LMICs, highlighting the need to increase access to natural environments in urban areas to improve mental health and well-being in public health emergencies.

Integrating health belief model and theory of planned behavior to assess COVID-19 vaccine acceptance among urban slum people in Bangladesh.

INTRODUCTION: The vaccination against coronavirus disease 2019 (COVID-19) has been identified as a promising strategy to reduce the severity of the pandemic. Despite the safe and effective COVID-19 vaccines, bringing socioeconomically disadvantaged people under vaccination coverage has been challenging for developing countries like Bangladesh. Therefore, this study explored the determinants of vaccine acceptance among urban slum residents of Bangladesh using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB). METHODS: A face-to-face survey of 400 urban slum dwellers in two large cities in Bangladesh was conducted between July 5 to August 5, 2021. The questionnaire included vaccine acceptance, socio-demographics, health-related characteristics, trust in health authorities, reasons for vaccine hesitancy, and dimensions of HBM and TPB frameworks. Hierarchical logistic regression was performed to evaluate the association between these characteristics and vaccination acceptance. RESULTS: Around 82% (n = 327) of respondents were willing to accept the COVID-19 vaccine. In a fully adjusted model, respondents with secondary level education had higher intention (OR = 46.93, 95%CI = 1.21-1807.90, p < 0. 05) to accept COVID-19 vaccine. Respondents with bad (OR = 0.11, 95%CI = 0.01-0.35, p<0.05) or very bad (OR = 0.01, 95%CI = 0.01-0.35, p<0.05) health conditions were less interested in the COVID-19 vaccination. In regard to HBM dimensions, greater perceived susceptibility (OR = 1.75, 95% CI = 1.12-2.75, p < 0.05), and perceived benefits (OR = 3.28, 95% CI = 1.17-6.00, p < 0.001) were associated with a greater willingness to get vaccinated. In regard to TPB, higher self-efficacy in preventing illness without the vaccine increased the desire to get vaccinated (OR = 1.55, 95% CI = 1.02-2.37, p < 0.05). Fear of unknown side effects, religious beliefs, contraindications to vaccination, and insufficient information on the vaccine were the main reasons for vaccine hesitancy. CONCLUSIONS: These findings offer valuable insights for policymakers in Bangladesh to design targeted interventions that address vaccine hesitancy and increase vaccination acceptability among socially disadvantaged individuals in urban areas. Strategies should focus on providing accurate and accessible information about the vaccine, communicating its positive impact effectively, engaging with religious leaders to address misconceptions, and tailoring vaccination campaigns to meet the unique needs of different demographic groups.

Psychological determinants of COVID-19 vaccine acceptance among urban slum dwellers of Bangladesh.

Introduction: Coronavirus disease 2019 (COVID-19) vaccination has emerged as a promising approach to counter the harmful impacts of the pandemic. Understanding the psychological components that may impact an individual's attitude toward COVID-19 vaccination is crucial for generating evidence-based ways to minimize vaccine hesitancy. This study determined the psychological antecedents regarding vaccine acceptance among urban slum people of Bangladesh. Methods: From 5 July to 5 August 5, 2021, a face-to-face survey was conducted in the urban slum of two large cities in Bangladesh. The questionnaire considered socio-demographics, health-related characteristics, psychological determinants, sources of information, and conspiracy beliefs regarding COVID-19. The 5C sub-scales were used to assess psychological antecedents. Five stepwise binary logistic regression models evaluated significant predictors for confidence, complacency, calculation, constraints, and collective responsibility. Multinomial logistic regression was used to determine the relationship between psychological antecedents and vaccine acceptability. Results: The study revealed that the slum residents with a high level of confident (89.94%), complacent (72.73%), having constraints (82.31%), calculative (84.80%), and responsible (93.30%) showed a higher vaccine acceptance rate. Higher vaccine acceptance was related to the believer in natural-made origin (85.96%) and those who rejected anti-vaccination (88.44%). The information acquired from newspapers differed significantly (p < 0.05), though TV or radio was the most common primary information source about COVID-19 vaccines (74.75%). The regression result revealed that marital status, education, family income, and perceived health condition were significantly associated with the 5C domains. Two psychological antecedents including complacency (OR = 3.97; p < 0.001) and collective responsibility (OR = 0.23; p < 0.001) were significantly associated with vaccine acceptance. Conclusions: Different predictors significantly affect psychological antecedents related to COVID-19 vaccine uptake. Therefore, considering the factors, targeted actions based on the findings may help to lower vaccine reluctance and boost vaccination rates.

Mental Health Status of University Students and Working Professionals during the Early Stage of COVID-19 in Bangladesh.

A novel coronavirus disease known as COVID-19 has spread globally and brought a public health emergency to all nations. To respond to the pandemic, the Bangladesh Government imposed a nationwide lockdown that may have degraded mental health among residents, in particular, university students and working professionals. We examined clinically significant anxiety levels with the Generalized Anxiety Disorder (GAD-7) scale and perceived stress levels with the Perceived Stress Scale (PSS-4) in an online cross-sectional study with 744 adults. Approximately 70% of respondents were afflicted with clinically significant anxiety levels, and more than 43.82% were afflicted with moderate or high perceived stress levels. Multivariate logistic regression models showed that postgraduates (OR = 2.78, 95% confidence interval [CI] = 1.03−8.75, p < 0.05) were more likely to experience anxiety than their student counterparts. No such differences emerged for working professionals, however. Living with family members compared to living alone was a risk factor for perceived stress among working professionals (OR = 4.05, 95% CI = 1.45−11.32, p < 0.05). COVID-19 stressors such as financial hardship (OR = 1.84, 95% CI = 1.11−3.05, p < 0.05) and worries of family members' health (OR = 1.84, 95% CI = 1.12−2.99) were risk factors for anxiety among students. Questionable social media news exposure (OR = 2.99, 95% CI = 1.13−7.92, p < 0.05) contributed to the development of mental stress among working professionals. These findings confirm that effective initiatives and proactive efforts from concerned authorities are necessary to cope with the mental health correlates of the COVID-19 pandemic, including in developing contexts such as Bangladesh.

COVID-19 Vaccine Acceptance Rate and Its Factors among Healthcare Students: A Systematic Review with Meta-Analysis.

Healthcare students are clinicians-in-training likely to come into contact with COVID-19 as much as other frontline healthcare professionals. It is therefore necessary to prioritize vaccinations for this group. We conducted a global systematic assessment of COVID-19 vaccine acceptance rates and related factors among healthcare students using the PubMed, Scopus, and Web of Science databases and keyword searches in March of 2022. We found 1779 articles with relevant information and 31 articles that matched our inclusion criteria. We performed a random-effects meta-analysis and quality assessment using the eight-item Joanna Briggs Institute Critical Appraisal test for cross-sectional studies. A total of 30,272 individuals from 16 countries were studied. Most of the studies were carried out in the U.S. (n = 6), China (n = 5), Poland (n = 5), India (n = 2), Italy (n = 2), and Israel (n = 2). The prevalence of the COVID-19 vaccine acceptance rate was 68.8% (95% confidence interval [CI]: 60.8-76.3, I2 = 100%), and the prevalence of the vaccine hesitancy rate was 25.8% (95% CI: 18.5-33.8, I2 = 99%). In country-specific analyses, Romania showed the highest acceptance rate (88.0%, 95% CI: 44.5-100%), while Iraq showed the lowest acceptance rate (66.2%, 95% CI: 35.5-90.8%). In time-trend analyses, we found that acceptance rates among healthcare students decreased over time. Students concerned about potentially serious side effects of the vaccine were less willing to accept the vaccine. National and international interventions should be adopted to reduce COVID-19 vaccination hesitancy rates among these important frontline workers.

Knowledge, Attitudes, and Practices Toward Coronavirus and Associated Anxiety Symptoms Among University Students: A Cross-Sectional Study During the Early Stages of the COVID-19 Pandemic in Bangladesh.

Background: University students' knowledge, attitude, and practice (KAP) toward COVID-19 are vital to prevent the spread of the virus, especially in the context of developing countries. Consequently, the present study aimed to determine the KAP levels of university students and associated anxiety during the earlier stage of the pandemic in Bangladesh. Methods: A cross-sectional, online study with 544 university students was conducted during April 17-May 1, 2020. The questionnaire incorporated several KAP-related test items aligned with the World Health Organization (WHO) guidelines. Anxiety was measured with the 2-item Generalized Anxiety Disorder scale (GAD-2). Multivariable logistic regression analysis was performed to determine the association between KAP levels and anxiety adjusting for sociodemographic variables. Subgroup analyses included rerunning models stratified by gender and quarantine status. Results: Approximately 50% of students showed high levels of knowledge about COVID-19 guidelines, 59% reported behavioral practices that aligned with COVID-19 guidelines, and 39% had negative attitudes toward COVID-19 guidelines. Attitudes differed by anxiety (χ2 = 23.55, p < 0.001); specifically, negative attitudes were associated with higher anxiety (OR: 2.40, 95% CI = 1.66-3.46, p < 0.001). Associations were significant for male (OR = 2.36; 95% CI = 1.45-3.84, p < 0.001) and female (OR = 2.45; 95% CI = 1.3-4.34; p < 0.001) students. Stratified analyses found non-quarantined students with negative attitudes had three times the chance of experiencing anxiety (OR = 3.14, 95% CI: 1.98-4.98, p < 0.001). Non-quarantined students with low levels of knowledge had half the chance of developing anxiety (OR = 0.49, 95% CI: 0.31-0.78, p < 0.01). Conclusion: Based on these findings, it is recommended that university authorities continue to prioritize proactive and effective measures to develop higher levels of knowledge, more positive attitudes and better behavioral practices regarding COVID-19 for the mental health of their students.

COVID-19 Vaccine Acceptance among Low- and Lower-Middle-Income Countries: A Rapid Systematic Review and Meta-Analysis.

Widespread vaccination against COVID-19 is critical for controlling the pandemic. Despite the development of safe and efficacious vaccinations, low-and lower-middle income countries (LMICs) continue to encounter barriers to care owing to inequitable access and vaccine apprehension. This study aimed to summarize the available data on COVID-19 vaccine acceptance rates and factors associated with acceptance in LMICs. A comprehensive search was performed in PubMed, Scopus, and Web of Science from inception through August 2021. Quality assessments of the included studies were carried out using the eight-item Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies. We performed a meta-analysis to estimate pooled acceptance rates with 95% confidence intervals (CI). A total of 36 studies met the inclusion criteria and were included in the review. A total of 83,867 respondents from 33 countries were studied. Most of the studies were conducted in India (n = 9), Egypt (n = 6), Bangladesh (n = 4), or Nigeria (n = 4). The pooled-effect size of the COVID-19 vaccine acceptance rate was 58.5% (95% CI: 46.9, 69.7, I2 = 100%, 33 studies) and the pooled vaccine hesitancy rate was 38.2% (95% CI: 27.2-49.7, I2 = 100%, 32 studies). In country-specific sub-group analyses, India showed the highest rates of vaccine acceptancy (76.7%, 95% CI: 65.8-84.9%, I2= 98%), while Egypt showed the lowest rates of vaccine acceptancy (42.6%, 95% CI: 16.6-73.5%, I2= 98%). Being male and perceiving risk of COVID-19 infection were predictors for willingness to accept the vaccine. Increasing vaccine acceptance rates in the global south should be prioritized to advance global vaccination coverage.

Determinants of COVID-19 Vaccine Acceptance among the Adult Population of Bangladesh Using the Health Belief Model and the Theory of Planned Behavior Model.

Vaccination is undoubtedly one of the most effective strategies to halt the COVID-19 pandemic. The current study aimed to investigate the acceptance of COVID-19 vaccination and its associated factors using two health behavior change frameworks: the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). A total of 639 Bangladeshi adults (mean age: 24 years) participated in a cross-sectional online study between July and August 2021. The questionnaire covered questions regarding vaccine intentions, sociodemographic features, health status, perceived trust in/satisfaction with health authorities, reasons for vaccine hesitancy, and factors related to the health behavior change frameworks. Hierarchical logistic regression was employed to determine associations between these predictors and vaccine acceptance. The intention to get a COVID-19 vaccination was expressed among 85% of the participants. In fully adjusted models, students and respondents with more normal body weights reported higher intentions to get vaccinated. Respondents were also more likely to seek vaccination if they reported greater levels of perceived susceptibility, benefits, and cues to action, as well as lower levels of barriers and self-efficacy. Fear of future vaccine side effects was the most common reason for COVID-19 vaccine hesitancy and was expressed by 94% of the vaccine-hesitant respondents. These factors should be considered by health authorities in Bangladesh and perhaps other countries when addressing the plateauing COVID-19 vaccination rates in many populations.

Association between Perceived Trusted of COVID-19 Information Sources and Mental Health during the Early Stage of the Pandemic in Bangladesh.

Unverified information concerning COVID-19 can affect mental health. Understanding perceived trust in information sources and associated mental health outcomes during the COVID-19 pandemic is vital to ensure ongoing media coverage of the crisis does not exacerbate mental health impacts. A number of studies have been conducted in other parts of the world to determine associations between information exposure relating to COVID-19 and mental health. However, the mechanism by which trust in information sources may affect mental health is not fully explained in the developing country context. To address this issue, the present study examined associations between perceived trust in three sources of information concerning COVID-19 and anxiety/stress with the mediating effects of COVID-19 stress in Bangladesh. An online cross-sectional study was conducted with 744 Bangladeshi adults between 17 April and 1 May 2020. Perceived trust in traditional, social, and health media for COVID-19 information, demographics, frontline service status, COVID-19-related stressors, anxiety (GAD-7), and stress (PSS-4) were assessed via self-report. Linear regression tested for associations between perceived trust and mental health. Mediation analyses investigated whether COVID-19-related stressors affected perceived trust and mental health associations. In fully adjusted models, more trust in social media was associated with more anxiety (B = 0.03, CI = 0.27-0.97) and stress (B = 0.01, CI = -0.34-0.47), while more trust in traditional media was associated with more anxiety (B = 0.09, CI = 0.17-2.26) but less stress (B = -0.08, CI = -0.89-0.03). Mediation analyses showed that COVID-19-related stressors partially explained associations between perceived trust and anxiety. These findings suggest that trusting social media to provide accurate COVID-19 information may exacerbate poor mental health. These findings also indicate that trusting traditional media (i.e., television, radio, and the newspaper) may have stress-buffering effects. We recommend that responsible authorities call attention to concerns about the trustworthiness of social media as well as broadcast positive and authentic news in traditional media outcomes based on these results.