COVID-19 vaccine hesitancy and attitudes in Pakistan: a cross-sectional phone survey of major urban cities.

BACKGROUND: COVID-19 mass vaccination is the only hopeful savior to curb the pandemic. Vaccine distribution to achieve herd immunity is hindered by hesitance and negative attitude of the public against COVID-19 vaccination. This study aims to evaluate the vaccine hesitancy and attitudes in major cities in Pakistan as well as their determinants. METHODS: A cross-sectional telephonic survey was conducted in June 2021 in major cities of Pakistan including Karachi, Lahore, Islamabad, Peshawar, and Gilgit, from unvaccinated urban population aged 18 years or older. Random Digit Dialing through multi-stage stratified random sampling was used to ensure representation of each target city and socio-economic classes. Questionnaire collected information on socio-demographics, COVID-19-related experiences, risk perception of infection, and receptivity of COVID-19 vaccination. Multivariate logistic regression analyses were performed to identify key determinants of vaccine hesitancy and acceptance. RESULTS: The prevalence of vaccinated population in this survey was 15%. Of the 2270 respondents, 65% respondents were willing to vaccinate, while only 19% were registered for vaccination. Factors significantly associated with vaccine willingness were older age (aOR: 6.48, 95% CI: 1.94-21.58), tertiary education (aOR: 2.02, 95% CI: 1.36, 3.01), being employed (aOR: 1.34, 95% CI: 1.01, 1.78), perceived risk of COVID-19 (aOR: 4.38, 95% CI: 2.70, 7.12), and higher compliance with standard operating procedures (aOR: 1.72, 95% CI: 1.26, 2.35). The most common vaccine hesitancy reasons were 'no need' (n = 284, 36%) and concerns with 'vaccine safety and side effects' (n = 251, 31%), while most reported vaccine motivation reasons were 'health safety' (n = 1029, 70%) and 'to end the pandemic' (n = 357, 24%). CONCLUSIONS: Although our study found 35% hesitancy rate of COVID-19 vaccine, there were noticeable demographic differences that suggest tailored communication strategy to address concerns held by most hesitant subpopulation. Use of mobile vaccination facilities particularly for less mobile and disadvantaged, and implementation and evaluation of social mobilization strategy should be considered to increase overall COVID-19 vaccination acceptance and coverage.

School closures help reduce the spread of COVID-19: A pre- and post-intervention analysis in Pakistan

Closing schools to control COVID-19 transmission has been globally debated, with concerns about children's education and well-being, and also because of the varied effectiveness of the intervention in studies across the world. This paper aims to determine the effect of school closure policy on the incidence of COVID-19 in Pakistan. A Difference-in-Differences (DiD) analysis compared changes in COVID-19 incidence across cities that completely (Islamabad) and partially (Peshawar) closed schools during the second wave of COVID-19 in Pakistan. Effects of closing (November 2020) and reopening schools (February 2021) were assessed in Islamabad and Peshawar 10 and 20 days after policy implementation. In Islamabad, there was a greater decline in cases than in Peshawar when schools closed. After 10-days, the average reduction of daily COVID-19 incidence in Islamabad was lower by 89 cases (95% CI: -196, 18), due to complete school closure, with a relative reduction of 125 cases (95% CI: -191, -59) compared to Peshawar. Similarly, the relative increase in Islamabad after schools re-opened was 107 cases (95% CI: 46, 167) compared to Peshawar. After 20-days, the average daily COVID-19 incidence in both cities declined after school were closed (Islamabad: -81 [95% CI: -150, -13] versus Peshawar: -80 [95% CI: -148, -12]). COVID-19 incidence appeared to decline after schools reopened as well (Islamabad: -116 [95% CI: -230, -3] versus Peshawar: -30 [95% CI: -124, 63]). However, Peshawar's decline is not statistically significant. These results control for changes in testing as well as a daily time trend. The magnitude and speed of reduction in cases with a complete school closure, and a similar but reverse trend of increasing cases upon reopening, suggests that closing schools reduces COVID-19 transmission in communities. However, there are learning-loss and well-being costs for children and their parents.

Impact of school closures and reopening on COVID-19 caseload in 6 cities of Pakistan: An Interrupted Time Series Analysis

Schools were closed all over Pakistan on November 26, 2020 to reduce community transmission of COVID-19 and reopened between January 18 and February 1, 2021. However, these closures were associated with significant economic and social costs, prompting a review of effectiveness of school closures to reduce the spread of COVID-19 infections in a developing country like Pakistan. A single-group interrupted time series analysis (ITSA) was used to measure the impact of school closures, as well as reopening schools, on daily new COVID-19 cases in 6 major cities across Pakistan: Lahore, Karachi, Islamabad, Quetta, Peshawar, and Muzaffarabad. However, any benefits were contingent on continued closure of schools, as cases bounced back once schools reopened. School closures are associated with a clear and statistically significant reduction in COVID-19 cases by 0.07 to 0.63 cases per 100,000 population, while reopening schools is associated with a statistically significant increase. Lahore is an exception to the effect of school closures, but it too saw an increase in COVID-19 cases after schools reopened in early 2021. We show that closing schools was a viable policy option, especially before vaccines became available. However, its social and economic costs must also be considered.

COVID-19 vaccination acceptance in underserved urban areas of Islamabad and Rawalpindi: results from a cross-sectional survey.

BACKGROUND: Urban slums are home to a significant number of marginalized individuals and are often excluded from public services. This study explores the determinants of willingness and uptake of COVID-19 vaccines in urban slums in Pakistan. METHODS: The study uses a cross-sectional survey of 1760 respondents from five urban slums in twin cities of Rawalpindi and Islamabad carried out between June 16 and 26, 2021. Pairwise means comparison tests and multivariate logistic regressions were applied to check the associations of socio-demographic factors and COVID-19 related factors with willingness to get vaccinated and vaccination uptake. RESULTS: Only 6% of the sample was fully vaccinated while 16% were partially vaccinated at the time of survey. Willingness to receive vaccination was associated with higher education (aOR: 1.583, CI: 1.031, 2.431), being employed (aOR: 1.916, CI: 1.423, 2.580), prior infection in the family (but not self) (aOR: 1.646, CI: 1.032, 2.625), family vaccination (aOR: 3.065, CI: 2.326, 4.038), knowing of and living close to a vaccination center (aOR: 2.851, CI: 1.646, 4.939), and being worried about COVID-19 (aOR: 2.117, CI: 1.662, 2.695). Vaccine uptake was influenced by the same factors as willingness, except worriedness about COVID-19. Both willingness and vaccination were the lowest in the two informal settlements that are the furthest from public facilities. CONCLUSIONS: We found low lived experience with COVID-19 infection in urban slums, with moderate willingness to vaccinate and low vaccination uptake. Interventions that seek to vaccinate individuals against COVID-19 must account for urban poor settlement populations and overcome structural barriers such as distance from vaccination services, perhaps by bringing such services to these communities.

Community engagement to increase vaccine uptake: Quasi-experimental evidence from Islamabad and Rawalpindi, Pakistan.

Developing countries have been facing difficulties in reaching out to low-income and underserved communities for COVID-19 vaccination coverage. The rapidity of vaccine development caused a mistrust among certain subgroups of the population, and hence innovative approaches were taken to reach out to such populations. Using a sample of 1760 respondents in five low-income, informal localities of Islamabad and Rawalpindi, Pakistan, we evaluated a set of interventions involving community engagement by addressing demand and access barriers. We used multi-level mixed effects models to estimate average treatment effects across treatment areas. We found that our interventions increased COVID-19 vaccine willingness in two treatment areas that are furthest from city centers by 7.6% and 6.6% respectively, while vaccine uptake increased in one of the treatment areas by 17.1%, compared to the control area. Our results suggest that personalized information campaigns such as community mobilization help to increase COVID-19 vaccine willingness. Increasing uptake however, requires improving access to the vaccination services. Both information and access may be different for various communities and therefore a "one-size-fits-all" approach may need to be better localized. Such underserved and marginalized communities are better served if vaccination efforts are contextualized.

Business analytics competencies in stabilizing firms’ agility and digital innovation amid COVID-19

Digital innovation is not a technology in itself but businesses’ ability to exploit digital technology to resolve outmoded problems. Digital innovation is leveraging improvements or innovating technology to reimagine business practice. The Coronavirus disease 2019 exerted enormous effects on people's physical and psychological health. In addition, this pandemic adversely affected the global economy, from sole proprietors to multinational firms. However, such an effect did not hinder versatile products, services, and upgraded versions of technologies. Modern firms rely heavily on available data sets to make decisions through analytics. Manufacturing is one of the most dynamic industries due to market pressures and continually changing customer demands. This study examines the relationship between business analytics competencies and digital innovation and explores the mediating role of absorptive capacity and firm agility. Data are collected from 493 managers of manufacturing firms and analyzed by using structural equation modeling through smart-PLS. Results reveal a positive relationship between business analytics competence and digital innovation mediated by absorptive capacity and firm agility. With its theoretical contributions, this study can initiate practical research outcomes in manufacturing firms.

Design and in silico analysis of mRNA vaccine construct against Salmonella.

Salmonella infections are continuously growing. Causative serovars have gained enhanced drug resistance and virulence. Current vaccines have fallen short of providing sufficient protection. mRNA vaccines have come up with huge success against SARS-CoV-2; Pfizer-BioNTech and Moderna vaccines have resulted in >90% efficacy with efficient translocation, expression, and presentation of antigen to the host immune system. Herein, based on the same approach a mRNA vaccine construct has been designed and analyzed against Salmonella by joining regions of genes of outer membrane proteins C and F of S. Typhi through a flexible linker. Construct was flanked by regulatory regions that have previously shown better expression and translocation of encoded protein. GC content of the construct was improved to attain structural and thermodynamic stability and smooth translation. Sites of strong binding miRNAs were removed through codon optimization. Protein encoded by this construct is structurally plausible, highly antigenic, non-allergen to humans, and does not cross-react to the human proteome. It is enriched in potent, highly antigenic, and conserved linear and conformational epitopes. Most conserved conformational epitopes of core protein lie on extended beta hairpins exposed to the cellular exterior. Stability and thermodynamic attributes of the final construct were found highly comparable to the Pfizer-BioNTech vaccine construct. Both contain a stable stem-loop structure downstream of the start codon and do not offer destabilizing secondary structures upstream of the start codon. Given structural and thermodynamic stability, effective immune response, and epitope composition the construct is expected to provide broad-spectrum protection against clinically important Salmonella serovars.Communicated by Ramaswamy H. Sarma.

School closures help reduce the spread of COVID-19: A pre- and post-intervention analysis in Pakistan.

Closing schools to control COVID-19 transmission has been globally debated, with concerns about children's education and well-being, and also because of the varied effectiveness of the intervention in studies across the world. This paper aims to determine the effect of school closure policy on the incidence of COVID-19 in Pakistan. A Difference-in-Differences (DiD) analysis compared changes in COVID-19 incidence across cities that completely (Islamabad) and partially (Peshawar) closed schools during the second wave of COVID-19 in Pakistan. Effects of closing (November 2020) and reopening schools (February 2021) were assessed in Islamabad and Peshawar 10 and 20 days after policy implementation. In Islamabad, there was a greater decline in cases than in Peshawar when schools closed. After 10-days, the average reduction of daily COVID-19 incidence in Islamabad was lower by 89 cases (95% CI: -196, 18), due to complete school closure, with a relative reduction of 125 cases (95% CI: -191, -59) compared to Peshawar. Similarly, the relative increase in Islamabad after schools re-opened was 107 cases (95% CI: 46, 167) compared to Peshawar. After 20-days, the average daily COVID-19 incidence in both cities declined after school were closed (Islamabad: -81 [95% CI: -150, -13] versus Peshawar: -80 [95% CI: -148, -12]). COVID-19 incidence appeared to decline after schools reopened as well (Islamabad: -116 [95% CI: -230, -3] versus Peshawar: -30 [95% CI: -124, 63]). However, Peshawar's decline is not statistically significant. These results control for changes in testing as well as a daily time trend. The magnitude and speed of reduction in cases with a complete school closure, and a similar but reverse trend of increasing cases upon reopening, suggests that closing schools reduces COVID-19 transmission in communities. However, there are learning-loss and well-being costs for children and their parents.

Acute Neurological Manifestations of COVID-19 Patients From Three Tertiary Care Hospitals in Qatar.

Introduction Worldwide, there are more than 424 million confirmed cases of COVID-19. Most of the hospitalized critical COVID-19 patients manifested neurological signs and symptoms and higher mortality. The majority of COVID-19 fatalities occurred mostly in patients with advanced age and underlying medical comorbidities. This is the first local retrospective study in Qatar, which reported neurologic manifestations (48.5%) of hospitalized COVID-19 patients. The primary objective of this study is to evaluate acute neurological manifestations in COVID-19 hospitalized patients in the country. Methods This is a retrospective, observational study of 413 hospitalized COVID-19 patients. They were admitted to three different COVID-19 designated hospitals (Hazm Mebaireek, Ras Laffan, and Cuban tertiary care Hospitals) under the Hamad Medical Corporation, Qatar from 1st January 2020, to 31 January 2021. We evaluated electronic medical records of these patients and data were collected while their neurological manifestations were confirmed by two trained neurologists. These neurologic manifestations were categorized into three major groups: central nervous system (CNS), peripheral nervous system (PNS), and neuromuscular system. Results Of 413 patients, 94% (389) were male and 6% (24) were female; the mean age was 52 years. Among all different nationalities of COVID-19 patients, 20.3% (84) were Indian, 12.5% (52) were Bangladeshi, 10.1% (42) were Qatari and 9.2% (38) were Nepali. The most common symptoms at the onset of COVID-19 illness were as follows: 77.5% (321) had a fever, 67.4% (279) experienced cough, 58.7% (243) experienced shortness of breath and 26.1% (108) developed a sore throat. Overall 48.5% (201) patients developed different neurologic manifestations. The most common neurologic symptoms were myalgia (28%; 116), headache (10.4%; 43), dizziness (5.8%; 24) and hemiparesis due to strokes (5.3%; 22). In this study, the most common risk factors were hypertension (47.6%), diabetes (46.9%), obesity (21%), chronic kidney disease (10%), ischemic heart disease (9.7%), and smoking (6.8%). About 45.2% (187) patients were admitted to MICU and 8.5% (35) died due to COVID-19 complications. Significant other extrapulmonary multiorgan system involvement were skeletal muscle injury (39.4%), kidney injury (36.7%), liver injury (27.5%), myocardial injury (23.9%), rhabdomyolysis (15.7%) heart failure (11.4%) and acute pancreatitis (11.1%). Discussion The most common neurologic signs and symptoms were myalgia, headache, dizziness, and strokes, mainly due to large vessel thrombosis, lacunar, and posterior circulation strokes. Conclusions Patients with COVID-19 are at high risk of developing neurological manifestations. The most common COVID-19-related acute neurological manifestations were myalgia, headache, dizziness, and acute ischemic stroke. Prompt recognition, early diagnosis, and appropriate management of these manifestations could potentially lead to better patient outcomes in COVID-19 patients.

Factors influencing eco-friendly apparel purchase behavior of Bangladeshi young consumers: case study

From demographic contexts in Bangladesh, it is felt that the young consumers covering a major portion of the total population are more fashion conscious followed by global fashion trends. [...]young consumers are spending more money for purchasing fashion product than before gradually and projected to increase in coming days. [...]in our knowledge, rare work has been done to measure the young consumers' PI for eco-friendly apparel especially from young consumers' contexts in Bangladesh. [...]understanding the factors of PI of apparel consumers of Bangladesh would help fashion retailers and practitioners in adopting strategic marketing approach for eco-friendly products. [...]driven by key literature analysis and considering the emerging contexts, the formulated objective of this study is to investigate the interplay of influencing factors of eco-friendly apparel purchase behaviors in relation to Bangladeshi young consumers in light of the theory of planned behavior (TPB). According to TPB, behavioral intention is the most desired variable to predict specific behavior.

Lessons learned in stroke care during COVID-19 pandemic and preparing for future pandemics in the MENA+ region: A consensus statement from the MENA+-SINO.

BACKGROUND: COVID-19 pandemic has negatively impacted stroke care services at multiple levels. There was a decline in acute stroke admissions. Fewer interventions have been performed. Increased "door-to-needle times and "door-to-groin puncture" during this pandemic. These factors combined have led to declining in the favoured outcomes of stroke patients' globally. Yet this pandemic permits an opportunity for higher preparedness for future pandemics. OBJECTIVES AND METHODS: This paper aims to shed light on the main lessons learned in the field of stroke care during the first wave of COVID-19 pandemic. Here we are presenting proposals and initiatives for better preparedness in future similar emergencies. These proposals are based primarily on literature review of COVID-19 publications, as well as the first-hand experience gained during the first wave at the regional level. In addition to the consensus and collective ride of stroke experts in the Middle East North Africa Stroke and Interventional Neurotherapies Organization (MENA+-SINO) and interaction and collaboration with international stroke specialists from the Stroke World Organization (WSO), European Stroke Organization (ESO) and stroke and COVID-19 papers authors. CONCLUSION: Stroke care is very complex, particularly in the initial hours after onset of symptoms. A successful outcome requires very close collaboration between clinical personnel from multiple specialties. Preparedness for future pandemics requires the improvement of care plans that allow for rapid assessment of stroke patients and ensuring that regular 'mock exercises' familiarize quintessential services that care for the stroke patients.

SARS-CoV-2 UK, South African and Brazilian Variants in Karachi- Pakistan.

The COVID-19 pandemic has been evolving in Pakistan with the emergence of the United Kingdom, South African, and Brazilian variants. These variants of concern (VOC) are known for increased transmissibility and can also be responsible for avoiding immune responses. The gold standard to detect VOC is sequencing, however routine genomic surveillance in resource-limited countries like Pakistan is not always readily available. The inadvertent detection of the B.1.1.7 (United Kingdom) VOC by a target failure due to the key deletion in spike Δ69-70 by commercially available PCR assay helps to understand target failures as an alternative approach to detect variants. In pursuit of VOC it was further discovered that a deletion in the ORF1a gene (ORF1a Δ3675-3677) is common in B.1.1.7, B.1.351 (South African), and P.1 (Brazilian) VOC. The Real-Time Quantitative PCR (RT-qPCR) assay can distinguish target failures and can discriminate SARS-CoV-2 VOC. The study uses positive samples archived in respective labs. Samples were divided into two groups. Group I constitutes 261 positive samples out of total of 16,964 (1.53%) performed from August till September 2020, while group II consists of 3501 positive samples out of a total of 46,041 (7.60%) performed, from November 2020 till January 2021. The RT-qPCR analysis showed that no VOC was present in positive samples of group I. However, a staggering difference in results was noted in group II where the positivity ratio increased exponentially and the VOC started appearing in significant numbers (53.64%). This concludes that the third wave in Pakistan is due to the importation of SARS-CoV-2 variants.

Effect of high and low risk susceptibles in the transmission dynamics of COVID-19 and control strategies.

In this study, we formulate and analyze a deterministic model for the transmission of COVID-19 and evaluate control strategies for the epidemic. It has been well documented that the severity of the disease and disease related mortality is strongly correlated with age and the presence of co-morbidities. We incorporate this in our model by considering two susceptible classes, a high risk, and a low risk group. Disease transmission within each group is modelled by an extension of the SEIR model, considering additional compartments for quarantined and treated population groups first and vaccinated and treated population groups next. Cross Infection across the high and low risk groups is also incorporated in the model. We calculate the basic reproduction number [Formula: see text] and show that for [Formula: see text] the disease dies out, and for [Formula: see text] the disease is endemic. We note that varying the relative proportion of high and low risk susceptibles has a strong effect on the disease burden and mortality. We devise optimal medication and vaccination strategies for effective control of the disease. Our analysis shows that vaccinating and medicating both groups is needed for effective disease control and the controls are not very sensitive to the proportion of the high and low risk populations.

Building trust in the state with information: Evidence from urban Punjab

Can communication designed to increase support for government policy and shift perceptions of state capacity redress deep-rooted mistrust in state institutions? This paper finds providing information on past state effectiveness, highlighting citizens’ cooperation in enabling past effectiveness or appealing to religious authorities’ support for government policy have limited impact on support for policy, perceptions of state capacity and trust in the state in Pakistan. This holds true on average and across important dimensions of heterogeneity after comparing treatment effects to those induced by an experimenter demand treatment. This paper highlights the limits of using information to build trust in state institutions, and the importance of measuring experimenter demand.

Fractional Operators Associated with the ք-Extended Mathieu Series by Using Laplace Transform

In this paper, our leading objective is to relate the fractional integral operator known as Pδ-transform with the ք-extended Mathieu series. We show that the Pδ-transform turns to the classical Laplace transform;then, we get the integral relating the Laplace transform stated in corollaries. As corollaries and consequences, many interesting outcomes are exposed to follow from our main results. Also, in this paper, we have converted the Pδ-transform into a classical Laplace transform by changing the variable lnδ−1s+1/δ−1⟶s;then, we get the integral involving the Laplace transform.

Laplace Operator with Caputo-Type Marichev–Saigo–Maeda Fractional Differential Operator of Extended Mittag-Leffler Function

In this paper, the Laplace operator is used with Caputo-Type Marichev–Saigo–Maeda (MSM) fractional differentiation of the extended Mittag-Leffler function in terms of the Laplace function. Further in this paper, some corollaries and consequences are shown which are the special cases of our main findings. We apply the Laplace operator on the right-sided MSM fractional differential operator and on the left-sided MSM fractional differential operator. We also apply the Laplace operator on the right-sided MSM fractional differential operator with the Mittag-Leffler function and the left-sided MSM fractional differential operator with the Mittag-Leffler function.

Statistics of viral infectivity in close contacts with COVID-19 patients: a joint hospital and community adventure in district Nowshera of Pakistan

Background: Present study was designed as to determine the probability and relative risk of COVID-19 in suspects with positive contacts history.

Analysis and prediction of the COVID-19 outbreak in Pakistan.

In this study, we estimate the severity of the COVID-19 outbreak in Pakistan prior to and after lockdown restrictions were eased. We also project the epidemic curve considering realistic quarantine, social distancing and possible medication scenarios. The pre-lock down value of R0 is estimated to be 1.07 and the post lock down value is estimated to be 1.86. Using this analysis, we project the epidemic curve. We note that if no substantial efforts are made to contain the epidemic, it will peak in mid-September, 2020, with the maximum projected active cases being close to 700, 000. In a realistic, best case scenario, we project that the epidemic peaks in early to mid-July, 2020, with the maximum active cases being around 120, 000. We note that social distancing measures and medication will help flatten the curve; however, without the reintroduction of further lock down, it would be very difficult to make R0<1 .