Attitudes towards COVID-19 vaccination and intention to get vaccinated in Western Balkans: cross-sectional survey.

BACKGROUND: Introduction of vaccines against COVID-19 has not encountered expected acceptance. The uptake of COVID-19 vaccines in Western Balkans countries is lagging behind the European Union average. The aim of our study was to assess the intention to get vaccinated against COVID-19 in the population of unvaccinated adult citizens of five Western Balkans countries, and to explore factors that influence the vaccination intention. METHODS: Cross-sectional study was conducted in the period from July to October 2021. The questionnaire was shared through online social media. Intention to get vaccinated against COVID-19 was measured by a single item assessing the likelihood of getting vaccinated on a 5-points Likert scale. Linear regressions were conducted with socio-demographic characteristics, presence of chronic diseases and attitudes towards COVID-19 vaccination as independent factors. RESULTS: The largest proportion of unvaccinated respondents willing to get vaccinated in the future was observed in Montenegro and Albania (40.4% in each country), while in the Serbian sample, the willingness to get vaccinated was the lowest (22.6%). Socio-demographic characteristics were not significantly associated with the intention to get vaccinated against COVID-19 in most of the countries. In Albania, Bosnia and Herzegovina, North Macedonia and Serbia the strongest determinant of COVID-19 vaccination intention was the higher sense of social responsibility. CONCLUSIONS: Vaccination interventions and campaigns aiming to improve the COVID-19 vaccine uptake should be focussed on specific set of factors in each country, appealing to social responsibility as most prevalent determinant of vaccination intention in Western Balkans.

COVID - 19 in two dialysis centers situated in two neighbouring states of the Western Balkans.

BACKGROUND: Bosnia and Herzegovina (BiH) and Serbia are countries in the Western Balkans that share parts of their social and political legacy from the former Yugoslavia, such as their health care system and the fact that they are not members of European Union. There are very scarce data on COVID - 19 pandemic from this region when compared to other parts of the world and even less is known about its impact on the provision of renal care or differences between countries in the Western Balkans. MATERIALS AND METHODS: This observational prospective study was conducted in two regional renal centres in BiH and Serbia, during the COVID - 19 pandemic. We obtained demographic and epidemiological data, clinical course and outcomes of dialysis and transplant patients with COVID - 19 in both units. Data were collected a via questionnaire for two consecutive time periods: February - June 2020 with a total number of 767 dialysis and transplant patients in the two centres, and July - December 2020 with a total number of 749 studied patients, corresponding to two of the largest waves of the pandemic in our region. Departmental policies and infection control measures in both units were also recorded and compared. RESULTS: For a period of 11 months, from February to December 2020, 82 patients on in-centre haemodialysis (ICHD), 11 peritoneal dialysis patients and 25 transplant patients who tested positive for COVID-19. In the first study period, the incidence of COVID - 19 positive in Tuzla was 1.3% among ICHD patients, and there were no positive peritoneal dialysis patients, or any transplant patients who tested positive. The incidence of COVID-19 was significantly higher in both centres in the second time period, which corresponds to the incidence in general population. Total deaths of COVID-19 positive patients was 0% in Tuzla and 45.5% in Nis during first, and 16.7% in Tuzla and 23.4% in Nis during the second period. There were notable differences in the national and local/departmental approach to the pandemic between the two centres. CONCLUSION: There was poor survival overall when compared to other regions of Europe. We suggest that this reflects the lack of preparedness of both of our medical systems for such situations. In addition, we describe important differences in outcome between the two centres. We emphasize the importance of preventative measures and infection control and highlight the importance of preparedness.

Characteristics and Outcomes of Critically Ill Pregnant/Postpartum Women with COVID-19 Pneumonia in Western Balkans, The Republic of Srpska Report.

Background and Objectives: Coronavirus disease 2019 (COVID-19) is a novel infectious disease that has spread worldwide. As of 5 March 2020, the COVID-19 pandemic has resulted in approximately 111,767 cases and 6338 deaths in the Republic of Srpska and 375,554 cases and 15,718 deaths in Bosnia and Herzegovina. Our objective in the present study was to determine the characteristics and outcomes of critically ill pregnant/postpartum women with COVID-19 in the Republic of Srpska. Materials and Methods: The retrospective observational study of prospectively collected data included all critically ill pregnant/postpartum women with COVID-19 in a university-affiliated hospital between 1 April 2020 and 1 April 2022. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. Patients' demographics, clinical and laboratory data, pharmacotherapy, and neonatal outcomes were analysed. Results: Out of the 153 registered pregnant women with COVID-19 treated at the gynaecology department of the University Clinical Centre of the Republic of Srpska, 19 (12.41%) critically ill pregnant/postpartum women (median age of 36 (IQR, 29-38) years) were admitted to the medical intensive care unit (MICU). The mortality rate was 21.05% (four patients) during the study period. Of all patients (19), 14 gave birth (73.68%), and 4 (21.05%) were treated with veno-venous extracorporeal membrane oxygenation (vvECMO). Conclusions: Fourteen infants were born prematurely and none of them died during hospitalisation. A high mortality rate was detected among the critically ill pregnant/postpartum patients treated with mechanical ventilation and vvECMO in the MICU. The preterm birth rate was high in patients who required a higher level of life support (vvECMO and ventilatory support).

Validation of the fear of COVID-19 scale in a central Balkan country - Serbia.

Validation of the fear of introduction: High levels of fear of COVID-19 may be associated with increased levels of stress, anxiety, and depression, as well as decreased resilience and life expectancy. Objective: This study aimed to translate and confirm the Serbian version of the Fear of COVID-19 scale as well as to investigate its psychometric properties. Methods: The translation and intercultural adaptation of the Fear of COVID-19 scale was performed by the leading standard of the International Society for Pharmacoeconomics and Outcome Research. When the distribution was normal, the Kolmogorov-Smirnov test was used. The reliability of the Serbian version of FCV-19S was tested by measuring the internal consistency through the value of Cronbach's alpha. Results: The original version of the Fear of COVID-19 scale was tested on a sample of 256 subjects with a mean age of 25.38 ± 12.47. The Cronbach's alpha value was 0.864. We divided the scale by the split-half method (Spearman-Brown), and the value of the coefficient for the questionnaire as a whole was 0.882. Divergent criterion validity was tested through the non-parametric correlation between the scores of the Fear of COVID-19 scale and the Fear of Hospitalization scale. A score of the Fear of COVID-19 scale was calculated as the sum of each question for each of the respondents. Convergent criterion validity was tested through the non-parametric correlation between the scores of the Fear of COVID-19 scale and the Emotional Regulation Questionnaire. Conclusion: The validated version of the scale in Serbia complements versions available in other cultures and other languages and facilitates global studies related to mental health during the COVID-19 pandemic.

(Dis)trust in doctors and public and private healthcare institutions in the Western Balkans.

INTRODUCTION: Considering the geopolitical changes in the six Western Balkan countries-Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia-over the last three decades, particularly as it concerns the progress and changes in the healthcare systems, we argue that there is a need for a detailed analysis of people's trust in those healthcare systems and healthcare providers. METHODS: In this cross-sectional, intercountry study, we examine the trust trends of Western Balkans citizens in medical doctors and public and private healthcare institutions from 25 July 2021 to 30 October 2021, with 3789 participants using a self-reported questionnaire, and Google Forms. Snowball sampling is used to collect data from six Western Balkans countries: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia. FINDINGS: The primary findings of our study show that citizens in the Western Balkans have a low level of trust in their healthcare system (X̄ = 4.3/10). Medical doctors working in private healthcare institutions, on the other hand, are afforded a higher level of trust (X̄ = 6.6/10) than those working in public healthcare institutions (X̄ = 5.7/10). In the event that they or their family members need to visit a health institution, half of the study participants would choose private healthcare institutions over public ones. We found a statistically significant difference between countries on the mean points from the questions concerning one's trust in the healthcare system, private healthcare institutions and medical doctors working in public and private sectors (p < .05). CONCLUSION: Despite its limitations, this study is the first cross-sectional research on the 'trust interface' among western Balkan citizens, revealing that they have low trust in their healthcare systems. PUBLIC CONTRIBUTION: The information in this manuscript was gathered on the level of 3789 citizens from six Western Balkan countries. Before we began collecting data, we conducted a piloting procedure with 40 citizens who were clients of health institutions to validate the data collection questionnaire.

Sleep quality and patterns of young West Balkan adults during the third wave of COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: To evaluate the sleep patterns among young West Balkan adults during the third wave of the COVID-19 pandemic. DESIGN AND SETTING: Cross-sectional study conducted using an anonymous online questionnaire based on established sleep questionnaires Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) (February-August 2021). PARTICIPANTS: Young adults of Bosnia and Herzegovina, Croatia and Serbia. RESULTS: Of 1058 subjects, mean age was 28.19±9.29 years; majority were women (81.4%) and students (61.9%). Compared with before the pandemic, 528 subjects (49.9%) reported a change in sleeping patterns during the pandemic, with 47.3% subjects reporting sleeping less. Mean sleeping duration during the COVID-19 pandemic was 7.71±2.14 hours with median sleep latency of 20 (10.0-30.0) min. Only 91 (8.6%) subjects reported consuming sleeping medications. Of all, 574 (54.2%) subjects had ISI score >7, with majority (71.2%) having subthreshold insomnia, and 618 (58.4%) PSQI score ≥5, thus indicating poor sleep quality. Of 656 (62.0%) tested subjects, 464 (43.9%) were COVID-19 positive (both symptomatic and asymptomatic) who were 48.8%, next to women (70%), more likely to have insomnia symptoms; and 66.9% were more likely to have poor sleep quality. Subjects using sleep medication were 44 times, and subjects being positive to ISI 15.36 times more likely to have poor sleep quality. In contrast, being a student was a negative independent predictor for both insomnia symptoms and poor sleep quality, and mental labour and not working were negative independent predictors for insomnia symptoms. CONCLUSIONS: During the third wave of the pandemic, sleep patterns were impaired in about half of young West Balkan adults, with COVID-19-positive subjects and being women as positive independent predictors and being a student as negative independent predictor of impaired sleep pattern. Due to its importance in long-term health outcomes, sleep quality in young adults, especially COVID-19-positive ones, should be thoroughly assessed.

COVID-19 diplomacy: analysis of Serbia COVID-19 vaccine strategy in the western Balkans.

Serbia's regional influence in the western Balkans enhanced strategic geopolitical partnership with Russia and China during COVID-19 pandemic. This paper critically analyzes Serbia COVID-19 vaccine strategy to the public health in the western Balkans. Importantly, this paper proposes strategic policy by enhancing 'joint coordinated EU-US-western Balkans COVID-19 vaccine manufacturing production' to accelerate inoculation, address gaps on vaccine hesitancy and promote long-term post-pandemic recovery plan to build back together and achieve herd immunity.