Children's rates of COVID-19 vaccination as reported by parents, vaccine hesitancy, and determinants of COVID-19 vaccine uptake among children: a multi-country study from the Eastern Mediterranean Region.

BACKGROUND: Huge efforts are being made to control the spread and impacts of the coronavirus pandemic using vaccines. However, willingness to be vaccinated depends on factors beyond the availability of vaccines. The aim of this study was three-folded: to assess children's rates of COVID-19 Vaccination as reported by parents, to explore parents' attitudes towards children's COVID-19 vaccination, and to examine the factors associated with parents' hesitancy towards children's vaccination in several countries in the Eastern Mediterranean Region (EMR). METHODS: This study utilized a cross-sectional descriptive design. A sample of 3744 parents from eight countries, namely, Iraq, Jordan, Kuwait, Lebanon, Palestine, Qatar, Saudi Arabia (KSA), and the United Arab Emirates (UAE), was conveniently approached and surveyed using Google forms from November to December 2021. The participants have responded to a 42-item questionnaire pertaining to socio-demographics, children vaccination status, knowledge about COVID-19 vaccines, and attitudes towards vaccinating children and the vaccine itself. The Statistical Package for Social Sciences (SPSS- IBM, Chicago, IL, USA) was used to analyze the data. A cross-tabulation analysis using the chi-square test was employed to assess significant differences between categorical variables and a backward Wald stepwise binary logistic regression analysis was performed to assess the independent effect of each factor after controlling for potential confounders. RESULTS: The prevalence of vaccinated children against COVID-19 was 32% as reported by the parents. Concerning parents' attitudes towards vaccines safety, about one third of participants (32.5%) believe that all vaccines are not safe. In the regression analysis, children's vaccination was significantly correlated with parents' age, education, occupation, parents' previous COVID-19 infection, and their vaccination status. Participants aged ≥50 years and those aged 40-50 years had an odds ratio of 17.9 (OR = 17.9, CI: 11.16-28.97) and 13.2 (OR = 13.2, CI: 8.42-20.88); respectively, for vaccinating their children compared to those aged 18-29 years. Parents who had COVID-19 vaccine were about five folds more likely to vaccinate their children compared with parents who did not receive the vaccine (OR = 4.9, CI: 3.12-7.70). The prevalence of children's vaccination in the participating Arab countries is still not promising. CONCLUSION: To encourage parents, vaccinate their children against COVID-19, Arab governments should strategize accordingly. Reassurance of the efficacy and effectiveness of the vaccine should target the general population using educational campaigns, social media, and official TV and radio channels.

Beliefs Toward Smoking and COVID-19, and the Pandemic Impact on Smoking Behavior and Quit Intention: Findings from a Community-Based Cross-Sectional Study in Jordan.

BACKGROUND: The relationship between smoking and coronavirus disease-2019 (COVID-19) is still topical with mixed epidemiological evidence. However, the pandemic may affect people's beliefs toward smoking as well as their smoking behavior and quit intentions. Considering high smoking rates in Jordan, our current study aimed to assess the following domains in a community-based sample from Jordan: (i) the beliefs that surround smoking/vaping and COVID-19 and (ii) the pandemic impact on smoking behavior and quit intention. METHODS: A cross-sectional study was conducted in Jordan from March 9 to March 16, 2021, utilizing a web-based structured questionnaire. The questionnaire comprised 13 items on sociodemographic, health, and smoking profiles, 14 items to assess beliefs surrounding COVID-19 and the use of combustible cigarettes (CCs), waterpipe (WP), and electronic cigarettes (ECs), and 12 items to assess the pandemic impact on smoking behavior and quit intention. RESULTS: Of 2424 survey respondents who participated in our study, there were 1163 never-smokers, 1044 current smokers, and 217 ex-smokers. The mean age of participants was 35.2 years (SD: 11.06). Most participants have reported anti-smoking beliefs with around 72.9% believed that WP smoking is related to the risk of contracting COVID-19. Also, 71.7% believed that smoking CC may worsen the COVID-19 clinical course, while 74.1% of respondents believed that smoking has no protective effect against COVID-19. During the pandemic, about 28.1% and 19.3% of current smokers reported increased or reduced smoking, respectively. Besides, 459 current smokers have expressed their plans/intention to quit smoking during the pandemic, of whom 27.5% (n = 126) confirmed that the driving force for their decision is a COVID-19-related reason, such as self-protection (n = 123) and protection of family members (n = 121) which were the most cited reasons. Also, around 63 participants have successfully ceased smoking during the pandemic. However, only 22 of them reported that the main driving motivation of their successful quit attempt was the COVID-19 pandemic. CONCLUSION: Most participants' beliefs and attitudes were against smoking during the pandemic. Nevertheless, the double-edged effect of the pandemic on smoking habits should be carefully considered, and reliable anti-smoking measures should be strengthened and sustained in the country.

Beyond equity: Advocating theory-based health promotion in parallel with COVID-19 mass vaccination campaigns.

Despite the challenges in managing the COVID-19 pandemic waves in different contexts and capacities, the vaccines that were recently approved for use have created a window of hope to fight this pandemic more effectively by achieving herd immunity. However, the rates of vaccination coverage vary considerably between countries. While looking at COVID-19 vaccination from a different perspective, it brings up the following question: is equitable vaccine delivery and access the only critical issue? Assessing facilitators and barriers to successful vaccination initiatives should be carefully considered and addressed by subsequent actions. The COVID-19 vaccination campaigns as part of disease prevention programs could be embedded in the core of theories for a more systematic approach to enhance vaccine acceptance among people. For effective implementation of public health programs, it is imperative to understand human health behaviours and to have sufficient knowledge about cultural and environmental influences. Sufficient and satisfactory COVID-19 vaccine uptake is not only challenged by the availability of vaccines or their distribution, but also by cultural and social norms in the community as well as the complexity of human behaviours. Therefore, the global efforts should target communities with theory-based health promotion and awareness programs in parallel with vaccination campaigns as a part of public health practice.

A swaying between successive pandemic waves and pandemic fatigue: Where does Jordan stand?

This article highlights the main aspects of Jordan's public health response in combating the COVID-19 pandemic. Also, it briefly describes the main characteristics of the pandemic waves. Although Jordan has successfully implemented various stringent control measures at the early stage of the pandemic which resulted in a slow pace of COVID-19 spread in the country, the dramatic and sudden surge in COVID-19 cases and deaths since September 2020 raises many concerns and questionable debates regarding the effectiveness of Jordan's COVID-19 mitigation strategies, the earlier epidemiological surveillance process, decision-making and decisions' execution at various sectors, as well as the degree of commitment to precautionary measures among the general population. Jordan has passed through three distinct pandemic stages so far, and each stage provides lessons that can be used to improve the national preparedness and response plan in the future. This pandemic has afflicted most life domains; thus, sharing the responsibility and efforts between the government and people in combating it, is expected to be more efficient and effective than a one-sided response. Pandemic fatigue can act as a major risk factor for losing such a battle. The people of Jordan have been already through an unforgettable 2020 year that impacted them physically, emotionally, and even financially. Therefore, reliable actions should be considered by the decision-makers to provide sufficient support for the society. Also, strengthening the government-public partnership is a cornerstone for a successful, solid, and effective public health response, especially in times of an exhaustive pandemic crisis like the COVID-19.