The effectiveness of vaccination for preventing hospitalisation with COVID-19 in regional Queensland: a data linkage study.

OBJECTIVE: To estimate the effectiveness of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for protecting people in a largely coronavirus disease 2019 (COVID-19)-naïve regional population from hospitalisation with symptomatic COVID-19. DESIGN: Retrospective cohort study; analysis of positive SARS-CoV-2 polymerase chain reaction (PCR) test results linked with Central Queensland hospitals admissions data and Australian Immunisation Register data. SETTING, PARTICIPANTS: Adult residents of Central Queensland, 1 January - 31 March 2022. MAIN OUTCOME MEASURES: Vaccine effectiveness (1 - relative risk of hospitalisation for vaccinated and unvaccinated people) with respect to protecting against hospitalisation with symptomatic COVID-19 after primary vaccination course only (two doses of an approved SARS-CoV-2 vaccine) and after a booster vaccine dose. RESULTS: Positive SARS-CoV-2 test results were recorded during 1 January - 31 March 2022 for 9682 adults, 7244 of whom had been vaccinated (75%); 5929 people were aged 40 years or younger (62%), 5180 were women (52%). Forty-seven people were admitted to hospital with COVID-19 (0.48%), four required intensive care (0.04%); there were no in-hospital deaths. Vaccine effectiveness was 69.9% (95% confidence interval [CI], 44.3-83.8%) for people who had received only a primary vaccination course and 81.8% (95% CI, 39.5-94.5%) for people who had also received a booster. Of the 665 Aboriginal and Torres Strait Islander adults with positive SARS-CoV-2 test results, 401 had been vaccinated (60%). Six Indigenous people were hospitalised with symptomatic COVID-19 (0.9%); vaccine effectiveness was 69.4% (95% CI, -56.5% to 95.8%) for Indigenous people who had received a primary vaccination course only or the primary course and a booster. CONCLUSION: The hospitalisation rate for Central Queensland people with PCR-confirmed Omicron variant SARS-CoV-2 infections during the first quarter of 2022 was low, indicating the protection afforded by vaccination and the value of booster vaccine doses.

SUpporting People in extreme POverty with Rehabilitation and Therapy (SUPPORT CP): A trial among families of children with cerebral palsy in Bangladesh.

AIM: To test the efficacy of an integrated microfinance/livelihood and community-based rehabilitation (IMCBR) programme in improving health-related quality of life (HRQoL) and motor function of children with cerebral palsy (CP) and gain in social capital to their ultra-poor families in rural Bangladesh. METHOD: This was an open-label cluster randomized control trial. Children with CP aged 5 years or under were randomly allocated to three arms; Arm A: IMCBR; Arm B: community-based rehabilitation (CBR); and Arm C: care-as-usual. The CBR was modified with phone follow-up followed by home-based CBR at 2.5 months post-enrolment because of the COVID-19 pandemic. Intention-to-treat analysis was performed. RESULTS: Twenty-four clusters constituting 251 children-primary caregivers' dyads were assigned to three arms (Arm A = 80; Arm B = 82; Arm C = 89). Between baseline and endline, the percentage mean change in the physical functioning domain of HRQoL was highest in Arm A (30.0%) with a significant mean difference between Arm A and Arm B (p = 0.015). Improvement in the mean social capital score was significantly higher in Arm A compared to Arm C (p < 0.001). INTERPRETATION: The findings suggest that IMCBR could improve the HRQoL of children with CP and the social capital of their ultra-poor families. Long-term follow-up of the trial participants and future exploration of such interventions are essential. The integrated livelihood and CBR programme holds potential to improve health and well-being of children with CP and their ultra-poor families. WHAT THIS PAPER ADDS: Half of the families who received livelihoods were impacted by a cold-wave, suggesting the need for a more disaster-resilient livelihood asset. The integration of livelihood with community-based rehabilitation programme helps to improve health-related quality of life of children with cerebral palsy and the social capital of their ultra-poor families.

Epidemiology of eye diseases among children with disability in rural Bangladesh: a population-based cohort study.

AIM: To describe the epidemiology of eye diseases among children with disability in rural Bangladesh. METHOD: We established a population-based cohort of children with disability using the key informant method. Children younger than 18 years with disability (i.e. physical, visual, hearing, speech, epilepsy) were included. We used detailed ophthalmological assessments following World Health Organization (WHO) protocols by a multidisciplinary team including an ophthalmologist, optometrist, physician, and physiotherapist. Visual impairment, blindness, and severe visual impairment (SVI) were defined by following WHO categories. RESULTS: Between October 2017 and February 2018, 1274 children were assessed (43.6% female; median [interquartile range] age 9y 10mo [6y -13y 7mo]). Overall, 6.5% (n=83) had blindness/SVI, and 5.6% (n=71) had visual impairment. In the group with blindness/SVI, 47% (n=39) had cortical blindness; of those, 79.5% (n=31) had cerebral palsy (CP). The other main anatomical sites of abnormalities in this group included lens (13.3%, n=11), cornea (10.8%, n=9), and optic nerve (9.6%, n=8). In the group with visual impairment, 90.1% (n=64) had refractive error. Overall, 83.1% (n=69) and 78.8% (n=56) of those with blindness/SVI and visual impairment had avoidable causes. Most children with blindness/SVI and visual impairment lacked access to education. INTERPRETATION: The burden of blindness/SVI/visual impairment is high among children with disability in rural Bangladesh, mostly due to avoidable causes. Overrepresentation of CP and cortical blindness in the group with blindness/SVI and refractive error in the group with visual impairment highlights the need for integration of ophthalmology assessment, eye care, and refraction services in comprehensive health care for children with disability including CP in rural Bangladesh.

Epidemiology of cerebral palsy in Sumba Island, Indonesia.

AIM: To define the epidemiology, clinical characteristics, and rehabilitation status of children with cerebral palsy (CP) in Sumba Island, Indonesia. METHOD: A community-based key informant method survey among children (aged <18y) with CP was conducted between March and August 2017. Children with suspected CP underwent detailed neurodevelopmental assessment by a multidisciplinary medical team. Socio-demographic characteristics, aetiology, motor type, motor severity, associated impairments, educational, and rehabilitation status were documented. RESULTS: There were 130 children with clinically confirmed CP. The mean age at assessment was 8 years 11 months and 43.8% (n=57) of the children were female. The mean age at CP diagnosis was 6 years 5 months. Of these children, 46.9% (n=61) had post-neonatally acquired CP, most frequently because of vaccine-preventable infectious encephalopathy (73.8%, n=45). In total, 80.8% (n=105) had a predominantly spastic motor type of CP and 83.8% (n=109) were classified in Gross Motor Functional Classification System levels III to V. A total of 77.7% (n=101) had at least one associated impairment (speech 77.5%, intellectual 29.2%, visual 13.8%, hearing 20.0%, and epilepsy 13.5%). And 66.2% (n=86) had never received rehabilitation services. INTERPRETATION: Post-neonatally acquired CP was common in this setting. Addressing preventable post-neonatally acquired risk factors for CP should be a public health priority. Earlier identification and diagnosis of CP would also provide new opportunities for early intervention and targeted rehabilitation services.

Hip dysplasia among children with spastic cerebral palsy in rural Bangladesh.

BACKGROUND: Hip dysplasia is common among children with cerebral palsy (CP), particularly in spastic CP. It can result in pain, reduced function and quality of life. However, the burden of hip dysplasia among children with CP in llow-and middle-income countries (LMICs) like Bangladesh is unknown. We aimed to define the burden of hip dysplasia among children with spastic CP in Bangladesh. METHODS: This study includes a subset of the Bangladesh CP Register (BCPR) study cohort who were registered between January and March 2015. The BCPR is a population-based surveillance of children with CP (aged < 18 years) operating in a northern sub-district (Shahjadpur; child population ~ 226,114) of Bangladesh. Community-based key informant's method (KIM) survey conducted to identify children with CP in the surveillance area. A diagnosis of CP was made based on clinical history and examination by the study physicians and physiotherapist. Study participants had an antero-posterior (AP) X-ray of their pelvis. The degree of subluxation was assessed by calculating the migration percentage (MP). RESULTS: During the study period, 196 children with CP were registered, 144 had spastic CP. 40 children with spastic CP (80 hips) had pelvic X-Rays (mean age 9.4 years, range 4.0-18.0 years) and 32.5% were female. Gross Motor Function Classification System (GMFCS) showed 37.5% (n = 15) with GMFCS level I-II and 62.5% (n = 25) with GMFCS level III-V. Twenty percent (n = 8) of the children had hip subluxation (MP: 33-80%). Osteopenic changes were found in 42.5% (n = 17) children. CONCLUSIONS: To the best of our knowledge this is one of the first studies exploring hip dysplasia among children with spastic CP in Bangladesh. Our findings reflect that hip dysplasia is common among children with spastic CP. Introduction of hip surveillance programmes is imperative for prevention of secondary complications, reduced function and poor quality of life among these children.

Evaluating Pilot Implementation of 'PenCS Flu Topbar' App in Medical Practices to Improve National Immunisation Program-Funded Seasonal Influenza Vaccination in Central Queensland, Australia.

BACKGROUND: The 'PenCS Flu Topbar' app was deployed in Central Queensland (CQ), Australia, medical practices through a pilot programme in March 2021. METHODS: We evaluated the app's user experience and examined whether the introduction of 'PenCS Flu Topbar' in medical practices could improve the coverage of NIP-funded influenza vaccinations. We conducted a mixed-method study including a qualitative analysis of in-depth interviews with key end-users and a quantitative analysis of influenza vaccine administrative data. RESULTS: 'PenCS Flu Topbar' app users reported positive experiences identifying patients eligible for NIP-funded seasonal influenza vaccination. A total of 3606 NIP-funded influenza vaccinations was administered in the eight intervention practices, 14% higher than the eight control practices. NIP-funded vaccination coverage within practices was significantly higher in the intervention practices (31.2%) than in the control practices (27.3%) (absolute difference: 3.9%; 95% CI: 2.9%-5.0%; p < 0.001). The coverage was substantially higher in Aboriginal and Torres Strait Islander people aged more than 6 months, pregnant women and children aged 6 months to less than 5 years for the practices where the app was introduced when compared to control practices: incidence rate ratio (IRR) 2.4 (95% CI: 1.8-3.2), IRR 2.7 (95% CI: 1.8-4.2) and IRR 2.3 (1.8-2.9) times higher, respectively. CONCLUSIONS: Our evaluation indicated that the 'PenCS Flu Topbar' app is useful for identifying the patients eligible for NIP-funded influenza vaccination and is likely to increase NIP-funded influenza vaccine coverage in the eligible populations. Future impact evaluation including a greater number of practices and a wider geographical area is essential.

Epidemiology of respiratory syncytial virus in Central Queensland, Australia.

Abstract: Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and pneumonia in infants. Little is known about the epidemiology, burden, and seasonality of RSV in subtropical regions of Australia like Central Queensland. This information is important to plan prevention strategies, including therapeutics, future vaccines, and health system preparedness. We collected data on laboratory-confirmed RSV cases and admissions in Central Queensland for the period 1 July 2021 to 31 December 2022. From July 2021, RSV was listed as a nationally notifiable condition on laboratory-confirmed diagnosis. During the study period, 1,142 laboratory-confirmed cases of RSV (50.0% female sex) were reported, with 169 cases (14.8%) requiring hospital admission, 12 of which (7.1%) required intensive care unit/high dependency unit admissions; two deaths occurred. Of cases requiring hospital admission, RSV was listed as the primary diagnosis in 113/169 cases (66.9%); 63/169 admitted cases (37.3%) had a major comorbidity. Of all cases, 55.4% were in children < 5 years of age (20.9% hospitalised); 35.7% in children < 2 years of age (24.3% hospitalised), and 19.1% in children < 12 months of age (27.5% hospitalised). Children under five years of age made up 78.1% of admissions, a rate of 9.0 admissions per 1,000 children over the 18-month study period, with an average age of 15.8 months (standard deviation, SD: 13.1 months) in this cohort. Indigenous children aged < 5 years were over-represented in cases (rate ratio, RR: 1.6; 95% confidence interval [95% CI]: 1.3-1.9) and admissions (RR: 1.6; 95% CI: 1.0-2.4). Antibiotics were prescribed to 48.5% of admitted cases under two years of age, despite documented bacterial infection in only 26.3% of these cases; antibiotic prescription was significantly higher in those who received a chest X-ray (p < 0.001). Of all cases, 33.5% occurred in July 2022 alone, with greater than 75.0% of cases occurring during June-August 2022. RSV showed year-round activity with a distinctive winter peak in 2022; however, this season was likely affected by coronavirus disease 2019 (COVID-19) restrictions and behaviours. Ongoing surveillance is required to better understand the epidemiology and seasonality of RSV in Central Queensland.

Prosthesis use among individuals with lower limb amputation in Bangladesh.

OBJECTIVE: This study aimed to assess factors related to prostheses use among individuals with lower limb amputation in Bangladesh. METHODS: Data related to prosthesis use, functional capabilities (as measured with the Locomotor Capabilities Index [LCI]), and user satisfaction were collected using telephone interviews between January 2014 and October 2016. Descriptive and regression analyses were performed. RESULTS: This study involved 183 participants (89.6% male); the mean (SD) age was 49.5 (10.7) years. Most of the participants (95.6%) used prostheses daily, and the mean (SD) duration of use was 7.0 (4.1) hours per day. The mean (SD) basic LCI score, advanced LCI score, and total LCI score were 25.1 (4.9), 20.8 (8.3), and 45.9 (12.2), respectively. Among them, 36.7% were dissatisfied with the weight of the prosthesis. Having a below knee amputation (odds ratio 2.6 and confidence interval 1.3, 5.3) and absence of comorbidities (odds ratio 2.1; confidence interval 1.0, 4.4) were associated significantly with an increased use of prosthesis. CONCLUSION: Factors such as weight of the prosthesis, amputation level, and presence of comorbidities are important considerations while planning for prosthetic rehabilitation and optimize utilization of the prosthetic devices.

Epidemiology of cerebral palsy among children in the remote Gorkha district of Nepal: findings from the Nepal cerebral palsy register.

PURPOSE: To describe the epidemiology of cerebral palsy (CP) among children in Gorkha, Nepal. METHODS: We established the first population-based register of children with CP aged <18 y in Gorkha, Nepal (i.e., Nepal CP Register). Children with suspected CP underwent detailed neurodevelopmental assessment by a multidisciplinary assessment team. Socio-demographic, etiology, motor severity, rehabilitation, and educational status were documented. RESULTS: Between January and October 2018, 182 children with confirmed CP were registered (mean (standard deviation (SD)) age: 10 years 1 months (4 years 10 months), 37.4% females). The majority (88.3%) had CP acquired pre- or perinatally. Mean (SD) age of CP diagnosis was four years five months. Mothers who did not receive any formal schooling had 4.5, 3.1, and 6.3 times higher odds of having inadequate antenatal care, homebirth, and unskilled birth attendants, respectively, when adjusted for other factors. Most children had spastic CP (77.5%) and Gross Motor Function Classification System level III-V (54.9%). Overall, 45.8% had never received rehabilitation services, 58.0% of school-aged children were not attending schools. The median age of receiving rehabilitation services was three years zero months. CONCLUSIONS: The delayed diagnosis and clinical severity indicate the overall poor health status of children with CP in Nepal which could be improved by ensuring early diagnosis and intervention. Implications for rehabilitationThe first population-based cerebral palsy register in Nepal suggests diagnosis of CP is considerably delayed among children.The high burden of severe motor impairment and poor communication skill with limited access to timely rehabilitation among children with CP in Nepal is concerning.Capacity development of community-based health workers and mothers of children with CP could help implementing community-based programs for prevention and early diagnosis of CP, and to promote early intervention for children with CP in remote Gorkha, Nepal.

Emergency Medical Service Response Time for Road Traffic Accidents in the Kingdom of Saudi Arabia: Analysis of National Data (2016-2020).

Despite preventive measures and initiatives, road traffic accidents are on the rise in the Kingdom of Saudi Arabia. This study aimed to investigate the emergency medical service unit's response to RTA by socio-demographic and accident-related variables in the Kingdom of Saudi Arabia. This retrospective survey included Saudi Red Crescent Authority data on road traffic accidents between 2016 and 2020. As part of the study, information on sociodemographic characteristics (e.g., age, sex, and nationality), accident-related data (type and place of the accident), and response time to road traffic accidents were extracted. Our study included 95,372 cases of road traffic accidents recorded by the Saudi Red Crescent Authority in the Kingdom of Saudi Arabia between 2016 and 2020. Descriptive analyses were performed to explore the emergency medical service unit's response time to road traffic accidents, and linear regression analyses were performed to investigate the predictors of response time. Most of the road traffic accident cases were among males (59.1%), and the age group of 25-34 years accounted for about a quarter (24.3%), while the mean age of the road traffic accident cases was 30.13 (±12.86) years. Among the regions, the capital city of Riyadh experienced the highest proportion of road traffic accidents (25.3%). In most road traffic accidents, the mission acceptance time was excellent (0-60 s; 93.7%), movement duration was excellent (<120 s; 91.1%), reaching site duration was excellent (<12 min; 57.9%), treatment start time was excellent (<120 s; 76.4%), duration at the scene was poor (>15 min; 40.8%), reaching hospital duration was good (30-60 min; 52.7%), and in-hospital duration was poor (>15 min; 44.1%). Regions, places and types of accidents, age, gender, and nationality of victims were significantly associated with different parameters of response time. Excellent response time was observed in most of the parameters except the duration at the scene, reaching hospital duration, and in-hospital duration. Apart from the initiatives to prevent road traffic accidents, policymakers should focus on strategies to improve accident response time to save lives.

Early Diagnosis of Cerebral Palsy in Low- and Middle-Income Countries.

Cerebral palsy describes a group of permanent disorders of movement, motor function and posture that occur due to non-progressive insults to the developing brain. Most of the information concerning the early diagnosis of cerebral palsy originates from studies conducted in high-income countries. In this scoping review, we aimed to explore the tools used in low- and middle-income countries for the early diagnosis of cerebral palsy. A systematic search was conducted using OVID Medline and PubMed databases. "Early diagnosis" was defined as diagnosis prior to 12 months of age, and low- and middle-income countries were classified according to the World Bank classification system. We identified nine studies on the early diagnosis of cerebral palsy from low- and middle-income countries. The tools featured (n = number of studies) were: General Movement Assessment (6), neonatal magnetic resonance imaging (3), Hammersmith Neonatal Neurological Examination (2), Hammersmith Infant Neurological Examination (1) and cranial ultrasound (1). We found a paucity of published literature on the early diagnosis of cerebral palsy from low- and middle-income countries. Further research is needed to determine the tools that are accurate and feasible for use in low-resource settings, particularly since cerebral palsy is more prevalent in these areas.

"Scary to get, more scary not to": COVID-19 vaccine acceptance among healthcare workers in Central Queensland, Australia, a cross-sectional survey.

Background: Behavioural and social drivers (BeSD) of coronavirus disease 2019 (COVID-19) vaccine acceptance among Australian healthcare workers (HCW) living and working in regional areas are not well studied. Understanding local HCWs' COVID-19 risk perceptions and potential barriers to COVID-19 vaccine uptake is crucial in supporting rollout. We aimed to understand the COVID-19 vaccine drivers among HCW in Central Queensland (CQ), Australia. Method: A cross-sectional online survey of HCWs in CQ between 17 May and 31 May 2021, based on the BeSD framework adapted from the World Health Organization (WHO) Data for Action guidance, consisting of the five instrument domains: what people think and feel; social processes; motivations; practical issues; and vaccination uptake. Results: Of the 240 responding HCWs within Central Queensland Hospital and Health Service, 78% were female. Of the participating HCWs, 64% percent had received at least one dose of a COVID-19 vaccine; of those who had not yet received a vaccine, 53% said they were willing to receive one. Factors associated with vaccine acceptance included: belief that the vaccine was important for their health (81%; odds ratio (OR): 7.2; 95% confidence interval (CI): 3.5-15.5); belief that their family and friends wanted them to have the vaccine (64%; OR: 6.7; 95% CI: 2.9-16.7); trust in the vaccine (72%; OR: 6.4; 95% CI: 3.5-12.0); and confidence in being able to answer patients' questions about the vaccine (99%). Conclusions: These findings suggest that a combination of communications and educational material framed around the benefits and social norms of vaccination, along with materials addressing vaccine safety concerns, will encourage HCW to take up a COVID-19 vaccine.

A Social Business Model of Early Intervention and Rehabilitation for People with Disability in Rural Bangladesh.

BACKGROUND: Despite the high burden of childhood disability in low-and middle-income countries (LMICs), the opportunity for early intervention and rehabilitation is very limited. Studies have found that community-based rehabilitation service is effective for children with cerebral palsy (CP); however, such services are not readily available in LMICs, and services run by non-profit organisations on external funding are often not sustainable. In this study, we report the lesson learnt in establishing a social business model of early intervention and rehabilitation services for children with CP and adults with disabilities in a rural subdistrict of Bangladesh. METHODS: Case study of a rural early intervention and rehabilitation centre (i.e., the model centre) implemented between May 2018 and September 2019. An economic evaluation incorporating gross margin analysis along with descriptive statistics was performed to assess the social business potentials of the model centre. RESULTS: The establishment of this model centre cost ~5955 USD with an average monthly running cost of ~994 USD. During the 17 months study period, 7038 therapy sessions (average eight sessions per patient) were offered to 862 patients with musculoskeletal and neurological disorders. The most common clinical presentations were low back pain (35.6%; n = 307). Six percent (n = 52) of the attendees were children with CP (mean (SD) age 6.3 (4.0) years; 35.7% (n = 19) were female), who received 1392 sessions, on average 27 sessions per child. The centre reached the break-even point at the 13th month and remained profitable for the next 4 months of the study period. An average session fee of 2.2 USD resulted in a gross margin of -1458 USD and 1940 USD in 2018 and 2019, respectively. Revenue to cost ratios for the 2 years were 0.27:1 and 0.51:1 while average rates of return were -41.4% and 10.1%, respectively. Sensitivity analysis revealed that session numbers including 5000, 6000, 7000, 8000, 9000, and 10,000 were required to break even at the session fees of 3.0, 2.50, 2.0, 2.0, 1.5, and 1.5 USD, respectively. CONCLUSION: Our social business model of an early intervention and rehabilitation service provides evidence of enhancing access to services for children with CP as well as adults with disabilities while ensuring the sustainability of the services in rural Bangladesh.

Situation analysis of rehabilitation services for persons with disabilities in Bangladesh: identifying service gaps and scopes for improvement.

PURPOSE: Rehabilitation needs are rising globally; however, the rate is strikingly higher in low- and middle-income countries (LMICs). Like many LMICs, the situation of rehabilitation services for persons with disabilities (PwDs) in Bangladesh is mostly unknown. We assessed the current situation of rehabilitation services for PwDs in Bangladesh. MATERIALS AND METHODS: This mixed-method study incorporated an online survey of rehabilitation service providers and a scoping review of documents published on rehabilitation services for PwDs in Bangladesh. Descriptive and thematic analyses were completed. RESULTS: A total of 1102 rehabilitation service providers were interviewed, and 36 documents were reviewed. Rehabilitation services for PwDs were found not integrated into the mainstream health services, financing mechanisms, information systems, and health policies in Bangladesh. There are 6.8 rehabilitation units for 1 million people, and 6.2% of them are located in rural areas. In terms of the rehabilitation workforce, there are 9.4 physiotherapists, 1.3 occupational therapists, 0.9 speech and language therapists, and 0.2 prosthetist and orthotists for 1 million people in Bangladesh. Majority (66.3%) of rehabilitation services require an out-of-pocket payment. CONCLUSIONS: A critical shortage and uneven distribution of the rehabilitation workforce are evident, indicating a likelihood of very high unmet rehabilitation needs in Bangladesh. To strengthen the rehabilitation capacity of Bangladesh, rehabilitation services should be integrated into mainstream health policies and programs with a special focus on the rehabilitation workforce training, recruitment and distribution, and allocation of resources.Implications for rehabilitationRehabilitation services in Bangladesh are mostly provided by the private sector, although the government of Bangladesh operates a small number of rehabilitation services outside of the mainstream public health service delivery system.Rehabilitation services are lacking in the primary and secondary health facilities, while services at tertiary level public hospitals are mainly provided by medical technologists in the absence of a qualified rehabilitation workforce.A severe shortage of rehabilitation workforce coupled with an uneven distribution of the existing limited number of rehabilitation services and out-of-pocket expenditures might result in inadequate access and poor rehabilitation service uptake amongst persons with disabilities (PwDs) in Bangladesh.Robust governance and leadership are needed to monitor the implementation of existing legislations and policies and develop strategies to improve the situation of rehabilitation services for PwDs in Bangladesh.

Vaccination Intention against COVID-19 among the Unvaccinated in Jordan during the Early Phase of the Vaccination Drive: A Cross-Sectional Survey.

Objective: This study assessed the intention and predictors of accepting the corona virus disease 2019 (COVID-19) vaccine in Jordan. Method: A national-level online survey was conducted among adults (≥18 years) in Jordan between June and September 2021. Descriptive analyses were performed to report vaccination intent. In addition, bivariate and multivariate logistic regression analyses were done to evaluate the association between vaccination intent and its predictors. Results: A total of 2307 adults participated. Most of them (83.7%) expressed an intention to receive a COVID-19 vaccine. Their vaccination intention was significantly (p < 0.001) associated with male gender (aOR: 2.6), residence in the Amman region (aOR: 51.8), and no history of COVID-19 infection (aOR: 6.0). In contrast, individuals aged 50-64 years (aOR: 0.2, p < 0.001), Jordanians (aOR: 0.7, p = 0.038), and those with an occupation designated as "other" (unemployed, general workers, housewives) (aOR: 0.2, p < 0.001) were less likely to have a positive vaccination intent. Among the health belief model constructs, perceived future (aOR: 2.8) and present (aOR: 5.0) susceptibility to COVID-19 infection; severity of complications (aOR: 9.9); and benefits (aOR: 100.8) were significantly (p < 0.001) associated with a higher likelihood of having a vaccination intent. On the other hand, individuals who are concerned about the efficacy (aOR: 0.2) and side effects (aOR: 0.2) of the vaccine were less likely to have a positive vaccination intent (p < 0.001). Conclusion: Despite having high rates of intention to receive a COVID-19 vaccine, Jordanians, older adults and housewives, general workers and unemployed individuals were less likely to be vaccinated. These findings highlight that need-based public health campaigns are necessary to ensure maximum COVID-19 vaccination uptake in Jordan.

Quality Improvement Attitudes among Saudi Nurses in Hospitals in Qassim, Saudi Arabia: A Cross-Sectional Survey.

BACKGROUND: This study aimed to provide an overview of perceptions of quality improvement among nurses working in Saudi Arabia. METHODS: We conducted a descriptive cross-sectional study of 497 Saudi nurses working in public and private hospitals in Al-Qassim Province. Descriptive statistics were computed for quality improvement nursing attitude items and demographic factors. RESULTS: A total of 497 nurses took part in the study; 29.1% of participants were females, and half of the participants were between the ages of 25-30 years. Most respondents were employed in governmental hospitals (98.7%), and 41.9% of participants had work experience ranging between 1 and 5 years. Nurses involved in providing direct patient care recognize the quality improvement attitudes related to changes in the healthcare delivery processes. Saudi nurses' quality improvement nursing attitudes were moderate. Female, married, and older age group nurses and nurses who were working fewer hours per week showed better quality improvement attitudes. CONCLUSIONS: Saudi nurses' quality improvement nursing attitudes are found to be moderate. Age, gender, marital status, and working hours of nurses are associated with their quality improvement attitudes. To empower nurses to improve healthcare, nursing administrators need to focus on improving the quality improvement attitudes environment.

Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review.

BACKGROUND: Malnutrition is substantially higher among children with cerebral palsy (CP) in low- and middle-income countries (LMICs) when compared with the general population. Access to appropriate interventions is crucial for better management of malnutrition and nutritional outcomes of those children. We aimed to review the existing evidence on nutrition interventions for children with CP in LMICs. METHODS: Online databases, i.e., PubMed and Scopus, and Google Scholar were searched up to 10 January 2022, to identify peer-reviewed publications/evidence on LMIC focused nutritional management guidelines/interventions. Following title screening and abstract review, full articles that met the inclusion/exclusion criteria were retained for data charting. Information about the study characteristics, nutrition interventions, and their effectiveness were extracted. Descriptive data were reported. RESULTS: Eight articles published between 2008 and 2019 were included with data from a total of n = 252 children with CP (age range: 1 y 0 m-18 y 7 m, 42% female). Five studies followed experimental design; n = 6 were conducted in hospital/clinic/center-based settings. Four studies focused on parental/caregiver training; n = 2 studies had surgical interventions (i.e., gastrostomy) and n = 1 provided neurodevelopmental therapy feeding intervention. Dietary modification as an intervention (or component) was reported in n = 5 studies and had better effect on the nutritional outcomes of children with CP compared to interventions focused on feeding skills or other behavioral modifications. Surgical interventions improved nutritional outcomes in both studies; however, none documented any adverse consequences of the surgical interventions. CONCLUSION: There is a substantial knowledge gap on nutrition interventions for children with CP in LMICs. This hinders the development of best practice guidelines for the nutritional management of children with CP in those settings. Findings suggest interventions directly related to growth/feeding of children had a better outcome than behavioral interventions. This should be considered in planning of nutrition-focused intervention or comprehensive services for children with CP in LMICs.

E-Cigarette Use among Male Smokers in Al-Ahsa, Kingdom of Saudi Arabia: A Cross-Sectional Study.

E-cigarette use is increasing globally. Recent evidence suggests that e-cigarettes contain harmful substances that could cause adverse health outcomes. This study investigated the prevalence and associated factors of e-cigarette use among male current smokers in Saudi Arabia. We conducted a cross-sectional survey of adult male current smokers in the Al-Ahsa province of Saudi Arabia. Data were collected using a structured questionnaire. We performed logistic regression analyses to investigate the factors associated with e-cigarette use among adult male current smokers. 325 current smokers participated in the study. A third of them (33.5%) were e-cigarette users. Almost all the study participants (97.0%) had heard about e-cigarettes. Participants who were occasional smokers (Odds Ratio (OR): 2.28; 95% Confidence Interval (CI): 1.17-4.41) and had good knowledge perception of e-cigarettes (OR 3.49; 95% CI: 2.07-5.90) had higher odds of using e-cigarettes when compared to regular smokers of conventional cigarettes and current smokers with poor knowledge perception of e-cigarettes, respectively. In contrast, private employees (OR: 0.25, 95% CI: 0.07-0.85), and business owners (OR: 0.09, 95% CI: 0.01-0.63) had lower odds of using e-cigarettes compared to unemployed individuals. Compared with non-e-cigarette users, the rate of conventional cigarette smoking per day was significantly lower among e-cigarette users. Use of e-cigarette (OR: 3.57, 95% CI: 2.14-5.98), believing that e-cigarette quitting is hard (OR: 2.02, 95% CI: 1.17-3.49) and trying to quit e-cigarettes (OR: 2.17, 95% CI: 1.1-4.25) were found to be significant predictors of good knowledge perception of e-cigarettes among the current smokers. The use and knowledge perception of e-cigarettes were higher among occasional conventional male cigarette smokers than regular male smokers in Al-Ahsa province. The use of e-cigarettes as smoking cessation aids should be examined further in the Saudi Arabian setting.

Nutritional status of children with cerebral palsy in remote Sumba Island of Indonesia: a community-based key informants study.

AIM: To assess the burden and underlying factors of malnutrition among children with cerebral palsy (CP) in the remote Sumba Island, Indonesia. METHODS: This is a community-based key informant (KI) method survey of children with CP in the southwest regency of Sumba Island, Indonesia (child population∼152 471). Children with suspected CP identified by trained community volunteers (KIs) underwent a detailed neurodevelopmental assessment by a multidisciplinary medical assessment team to confirm diagnosis of CP. Anthropometric measurements were taken, z scores were calculated, and nutritional status was determined following the World Health Organization guideline. Descriptive analyses were performed, multivariable linear regression model was fitted to identify potential predictors of malnutrition. RESULTS: One hundred and thirty children with CP aged <18 years were included in the study. The majority were severely underweight (78.8%) and severely stunted (85.9%). Severe malnutrition was overrepresented among young children, children who had spastic tri/quadriplegia, Gross Motor Function Classification System levels III-V, had at least one associated impairment, speech impairment and/or swallowing difficulties. Age and presence of visual impairment were found to be significantly associated with weight-for-age z score (i.e., underweight) whereas, epilepsy was significantly associated with the height-for-age z score (i.e., stunting) when adjusted for other covariates. CONCLUSIONS: The substantial-high burden of malnutrition among children with CP in remote Sumba Island highlights their vulnerability to poor health-related outcomes. There is an urgent need for nutritional rehabilitation services to avert such consequences among children with CP in low and middle-income countries like Indonesia.Implications for rehabilitationMalnutrition among children with cerebral palsy (CP) is alarmingly high in the remote Sumba island of Indonesia.Children with severe gross motor function limitations or spastic tri/quadriplegia had the most severe malnutrition.There is an urgent need for rehabilitation services including nutrition and feeding interventions for children with CP in low and middle-income countries like Indonesia.