Community voices around COVID-19 vaccine in Chennai, India: A qualitative exploration during early phase of vaccine rollout

Background & objectives: Globally, vaccination is considered as an important public health strategy to mitigate the impact of the COVID-19 pandemic. The purpose of the current study was to conduct an in-depth inquiry to explore perceptions of community members around COVID-19 vaccines in the southern city of Chennai, Tamil Nadu. This was conducted during the early phase of the vaccine rollout programme in India. Methods: A qualitative investigation was conducted between January-February 2021 through in-depth interviews. Healthcare workers, religious leaders, community influencers, local administrators and representatives of marginalized communities were included. The key informant interview guides and probes explored five domains; (i) vaccine availability, (ii) trust in COVID-19 vaccines, (iii) vaccine-related concerns, (iv) health/risk balance and (v) vaccine prioritization. Transcripted interviews were coded using a thematic approach and analyzed manually as well as with the help of ATLAS.ti 9 software. Results: Eagerness to receive COVID-19 vaccines amongst some of the respondents was linked with freedom from fear, possible restoration of normalcy, protection of family and ability to travel and work abroad. Concerns around threat of emergence of new variants, damage caused by such viral mutants and trust in policymakers were other facilitatory influencers for vaccine uptake. On the other hand, doubts surrounding safety and fear of side effects of COVID-19 vaccine were the feeders to vaccine hesitancy. Lack of accurate information, sensational media reports and rumours exacerbated this fear and provoked anxiety among people. Apprehensions around COVID-19 vaccine in the wake of its rapid development and approval for use and reluctance to take it during the declining phase of the epidemic were identified as other inhibitory factors. Participants underlined the importance of having responsive communication strategies in place focussing on vaccine safety. Making vaccines available to people free of cost and ensuring wider access were other programmatic suggestions. Interpretation & conclusions: In conclusion, our study findings suggest that it is essential to remain engaged with communities and execute evidence-based information dissemination strategy about the safety and efficacy of the vaccines. We identified that it is also imperative to sensitize and train media professionals on how to report side effects related to vaccines. Responsive communication strategies will thus have the potential to serve as a key public health approach pertaining to future pandemic preparedness as well as to manage the demands of clinical and public health issues in an ongoing pandemic situation.

Frontera dinámica: contraste urbano rural en el Borde oriental de Medellín Colombia / Dynamic Border: Rural Urban Contrast on the Eastern Edge in Medellin, Colombia

Resumen El límite de expansión urbana oriental de Medellín, Colombia, está dado por las zonas de protección ambiental y la frontera con el corregimiento de Santa Elena; sin embargo, esta delimitación es ambigua entre lo que se ha planteado en el Plan de Ordenamiento Territorial vigente y lo que se encuentra en la realidad: el barrio El Pacífico, último asentamiento de este borde se ha comenzado a expandir incluso, a la zona de protección y a los suelos de uso rural. Existe una clara distancia entre lo planteado y sentado en los instrumentos de planificación, con lo interpretado o percibido por la comunidad que habita el territorio en cuestión. Existe un contraste urbano rural dado por la dinámica que plantean los actores fronterizos.

Abstract The eastern urban expansion edge of Medellin, Colombia, is given by environmental protection zones and the border with the Santa Elena Village. However, this delimitation is ambiguous between what has been raised in the current Territorial Ordering Plan and what is in reality: The El Pacífico neighborhood. The last settlement of this border has even begun to expand to the protection zone and to rural-use soils. The re exists a clear distance between what is raised and what is seated in the planning instruments, with what is interpreted or perceived by the community, who inhabits the territory in question. There is a rural urban contrast given by the dynamics posed by bordering actors.

Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde: caminhos e desafios / Technical and socio-cultural contributions of quaternary prevention for primary health care: paths and challenges / Contribuciones técnicas y socioculturales de prevención cuaternaria para la atención primaria de salud: caminos y desafíos

Introdução: No contexto do Sistema Único de Saúde, o conceito da prevenção quaternária adentra timidamente os níveis de atenção à saúde, no entanto, sofre expansão significativa no âmbito da atenção primária à saúde. Objetivo: Identificar por meio da sistematização de evidências científicas, as contribuições técnicas e socioculturais da prevenção quaternária no âmbito da atenção primária à saúde no Brasil. Métodos: Trata-se de uma revisão integrativa de estudos presentes nas bases de dados científicas da Scientific Electronic Library Online, Biblioteca Virtual em Saúde, biblioteca virtual da Comissão de Aperfeiçoamento de Pessoal do Nível Superior e MEDLINE via PubMed com a utilização dos descritores "prevenção quaternária" e "atenção primária à saúde", em inglês e português. Resultados: O corpus de análise foi composto por 22 artigos, sendo que a produção científica sobre o tema se deu de forma mais intensa a partir do ano de 2015 e, em sua maioria, possuíam como abordagem metodológica ensaios teóricos. Dentre as contribuições técnicas destacaram-se a introdução do ensino da prevenção quaternária de modo continuado aos graduandos e profissionais; a construção de protocolos e documentos de amparo profissional; a utilização de modelos explicativos dinâmicos na socialização do quadro clínico; a conduta profissional com os usuários e as contribuições socioculturais envolvendo mudanças na percepção profissional e comunitária sobre o fenômeno saúde-doença, assim como o incentivo a práticas de desmedicalização sociocultural em relação à dor, incapacidade, desconforto, envelhecimento, nascimento e morte. Conclusão: Apesar do reconhecimento das potencialidades da prevenção quaternária, faz-se necessário fortalecer estratégias que possibilitem o desenvolvimento de políticas públicas para fomentar e gerenciar alianças estratégicas com tomadores de decisão, profissionais de saúde e cidadãos, para fomentar a redução de diagnósticos e tratamentos excessivos, contribuindo com a qualidade do cuidado.

Introduction: In the context of the Unified Health System, the concept of quaternary prevention shyly enters the levels of health care, however, undergoes significant expansion in the scope of primary health care. Objective: To identify, through the systematization of scientific evidence, the technical and socio-cultural contributions of quaternary prevention within the scope of primary health care in Brazil. Methods: This is an integrative review of studies present in the scientific databases of the Scientific Electronic Library Online, Regional Portal of the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization, virtual library of the Higher Education Personnel Improvement Commission, and MEDLINE through PubMed using the descriptors "quaternary prevention" and "primary health care", in English and Portuguese. Results: The corpus of analysis consisted of 22 articles, and the scientific production on the topic took place more intensively from the year 2015 and, for the most part, had theoretical essays as methodological approach. Among the technical contributions, we highlight the introduction of teaching on quaternary prevention in a continuous way to undergraduates and professionals; the construction of protocols and documents of professional support; the use of dynamic explanatory models in the socialization of the clinical picture and professional conduct with users and socio-cultural contributions involve changes in the professional and community perception about the phenomenon of illness and health conception, as well as the incentive to practices of socio-cultural demedicalization in relation to pain, disability, discomfort, aging, birth, and death. Conclusion: Despite the recognition of the potential of quaternary prevention, it is necessary to strengthen strategies that enable the development of public policies to foster and manage strategic alliances with decision makers, health professionals and citizens, to promote the reduction of excessive diagnoses and treatments, contributing to the quality of care.

Introducción: En el contexto del Sistema Único de Salud, el concepto de prevención cuaternaria entra tímidamente en los niveles de atención de salud, sin embargo, experimenta una expansión significativa en el alcance de la Atención Primaria de Salud. Objetivo: Identificar, a través de la sistematización de evidencia científica, las contribuciones técnicas y socioculturales de la prevención cuaternaria en el ámbito de la Atención Primaria de Salud en Brasil. Métodos: Esta es una revisión integradora de estudios presentes en las bases de datos científicas de la Biblioteca Electrónica Científica en línea, Portal Regional de la Biblioteca Virtual en Salud del Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud de la Organización Panamericana de la Salud, biblioteca virtual de la Comisión de Mejoramiento del Personal de Educación Superior y MEDLINE a través de PubMed utilizando los descriptores de prevención cuaternaria y atención primaria de salud, en inglés y portugués. Resultados: El corpus de análisis estuvo conformado por 22 artículos, siendo la producción científica sobre el tema más intensiva desde 2015 y, en su mayor parte, tuvo ensayos teóricos como abordaje metodológico. Entre los aportes técnicos, destacamos la implantación de la docencia en prevención cuaternaria de forma continua a estudiantes de pregrado y profesionales; construcción de protocolos y documentos de apoyo profesional, uso de modelos explicativos dinámicos en la socialización del cuadro clínico y conducta profesional con los usuarios y los aportes socioculturales implican cambios en la percepción profesional y comunitaria sobre el fenómeno de la enfermedad y la concepción de la salud, así como el incentivo a prácticas de desmedicalización sociocultural en relación al dolor, discapacidad, malestar, envejecimiento, nacimiento y muerte. Conclusión: A pesar del reconocimiento del potencial de la prevención cuaternaria, es necesario fortalecer estrategias que permitan el desarrollo de políticas públicas para fomentar y gestionar alianzas estratégicas con los tomadores de decisiones, profesionales de la salud y ciudadanos, para promover la reducción de diagnósticos y tratamientos excesivos, contribuyendo a la calidad de la atención.

Rural Communities’ Perceptions of Climate Change and Its Impacts on Their Livelihood in Southeastern Niger

Climate change exacerbates ecosystem degradation in Sahel where rural communities are highly dependent on natural resources and ecosystem services for their livelihoods. In order cope with the adverse effects of climate change by developing climate adaptation strategies, there has been a need to understand how communities perceive the change or variability in their local climate and how this change could affect their livelihood. This paper aims to examined rural communities’ perceptions about climate change in the commune of Chetimari located in the region of Diffa, southeastern Niger. It investigated particularly: 1) how communities’ perceptions of climate change? 2) What are the impacts of climate change on the livelihood of communities? And 3) What do elements and options to detect abrupt change points in annual precipitations and both annual maximum and minimum temperature? Survey data were collected from October to November 2018 from 101 households (15% of the total households in the study area) in three villages. Multiple correspondence Analysis (MCA) and Factorial Correspondence Analysis (FCA) were performed with XLSTAT to analyzed data from survey. Meteorological data including Monthly precipitation from 1981 to 2017, and Monthly temperatures (maximum, minimum) from 1986 to 2017 of the Diffa meteorological station were analyzed using R to perform the Man Kendal trend test and the Pettit test for detection of abrupt changes in the series. Results showed that community perceptions on temperature increase (not for precipitation) trends as indicators of climate change are in agreement with meteorologically observed trends. The findings showed that people in this zone are aware of climate change that they see as increase in maximum and minimum temperature, decrease in rainfall, frequency of extreme events (drought and flood), dry spells, decrease in number of rainy days, strong winds etc…Results revealed the most significant impacts of climate change affecting the livelihood of rural communities in this area. These are higher risk of crop damage from drought, farmer and herder conflict frequency, drying up of wells, food shortage/insecurity, silting pools, decline in soil fertility and livestock production, silting pasture areas, frequency of livestock diseases, increased weed and invasive species, livestock mortality. The perception of the climate change and its impacts on the main socioeconomic activities vary from a village to another, according the sexes and age ranges. We conclude that communities are relatively aware about the climate change issue. For a better management of climate-induced risks in the study area we stress the need to improve the awareness of climate change within the rural community by improving the availability and the quality of relevant climate information.

Risk factors in relation to neurological morbidity in children: a study on perception of health professionals and parents

Background: Morbidity resulting from various neurological illnesses is a common reason for seeking regular help from health care facilities. There is increased requirement of awareness about neurological, psychiatric, physical, and developmental disorders in the community. Present study was undertaken to assess the community awareness and perception of risk factors for neurodevelopmental disabilities in children.Methods: The study was conducted with an objective of finding out level of awareness of a group of young health professionals and parents regarding their perception of likely factors that contribute for the occurrence of neurodevelopmental disabilities. This was a cross sectional study with discussion between the participants of various groups by using the method of Focused Group Discussions. Perceived risk factors as emerged during the discussions were free-listed and categorized under Biological/Familial/Genetic factors, Environmental factors, Socio-cultural factors and Economic/ Financial factors.Results: Lack of prenatal care, prematurity, unaffordability of care, low birth weight, malnutrition, infections and lack of maternal education emerged as important risk factors for neuromorbidity as perceived by the participants. Participants also enumerated insufficient knowledge on preventable risk factors, lack of trained manpower and neglect of female children as important contributors to occurrence of developmental disabilities.Conclusions: It is of paramount importance to identify the community perception of the risk factors for developmental disability which gives us an estimate of awareness among people and caregivers. Interventions tailored to the needs based on the level of community awareness help us in better channelling of preventive programmes and strategies.

Equity in utilization of health care services: Perspective of pregnant women in southern Odisha, India.

Background & objectives: Inequity in the use of health care services is an important factor affecting the maternal and child survival. In southern Odisha, India, the health indicators remained below compared to the state and national average. This study identifies various equity issues at individual and community levels that influence women’s choice affecting the utilization of maternal health services in a district in southern Odisha. Methods: A qualitative study was carried out in Gajam district, rural region of south Odisha. Ten in-depth interviews were carried out till data saturation with women having less than one year child and 10 focus group discussions with the average eight women in each group having less than five year old child, community and health care providers separately. A total of 120 respondents were included in the study using in-depth interview and focus group discussions. Results: The important determinants in utilization of health care services by women emerging from the study were transportation and financial constraints. In addition, it was found that divergent aetiological concepts and low perceived hospital benefits of the women and community were equally important determinants. Further, community had different perceptions and interpretations of danger signs influencing the risk approach and health care seeking behaviour. Interpretation & conclusions: Our findings show that to increase the utilization of health care services, the grass root health workers should be made aware of specific social determinants of risk, perceptions and preferences. more attention should be given to the transportation system, and its operational feasibility. The husband of the women and the elders of the family should be considered as an important unit of interjection. A more individualized antenatal consultation could be provided by taking into account women’s perception of risk and their explanatory models.

The Community Knowledge and Practices Regarding Dengue Fever in an Urban Slum Area of South India.

Dengue/Dengue Hemorrhagic Fever (DHF) is an emergent disease in India. The present study was carried out with the aim of assessing knowledge regarding Dengue fever among community in an urban slum area of Andhra Pradesh. This cross sectional study was undertaken in an urban slum area of Uuban Health Centre, Guntur, which is a field practice area of Department of Community Medicine, Katuri Medical College and Hospital,Guntur. Out of 370 respondents, 291(78.65%) knew that dengue fever is transmitted by mosquito.Only 38(10.27%) persons could enumerate 3 symptoms of Dengue (fever, headache and bleeding). Regarding knowledge about breeding places only 276 (74.59%) respondents knew about breeding places of mosquitoes. Regarding the source of information on Dengue fever, 191 (51.62%) came to know about Dengue fever through television. Despite good awareness about dengue fever, adoption of the mosquito control methods was poor in the area.

Community awareness, perceptions, acceptability and preferences for using LLIN against malaria in villages of Uttar Pradesh, India.

Background & Objectives: Long-lasting insecticidal nets (LLINs) have been introduced in India recently into the vector control programme. A study was undertaken to assess the community perception regarding use of LLIN, their acceptability, collateral benefits, etc. in certain villages of District Gautam Budh Nagar, Uttar Pradesh, India where LLINs are in use by the community. Method: A randomized community-based survey was undertaken during April–May 2009 covering 596 respondents in LLIN villages where LLINs have been distributed along with 307 respondents in untreated net villages where untreated nets were distributed using structured questionnaire. Qualitative data were collected and the difference in proportion was calculated by z-test. Results: A substantial number of respondents had good knowledge of the symptoms of malaria. According to respondents, LLINs were very much effective in bringing down the malaria incidence in their families. About 98.3% of the respondents asserted the use of LLINs as their use not only reduced the number of mosquitoes as well as other non-target insects, but also reduced the malaria incidence. About 93.2% of the respondents were ready to purchase LLINs if available at nominal prices. All the respondents were satisfied about the performance of the LLINs in reducing the mosquito nuisance, safety of use and collateral benefits in LLIN villages. Conclusion: LLINs are safe, socially acceptable and should be promoted for vector control to reduce the disease burden in the communities.