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1.
Curr HIV/AIDS Rep ; 19(1): 37-45, 2022 02.
Article in English | MEDLINE | ID: covidwho-1748427

ABSTRACT

PURPOSE OF REVIEW: Latin America and the Caribbean (LAC) has been hit hard by COVID-19 due to political instability, flawed health systems, and structural inequalities. The repercussion of the pandemic on vulnerable populations, like people living with HIV (PLWH), is complex. This review aims to explore the interactions between the HIV and COVID-19 pandemics in this region. RECENT FINDINGS: Data regarding the interactions of HIV and COVID-19 in LAC is scarce. Only case reports or small case series have been published regarding the clinical course of COVID-19 in PLWH and regarding the clinical course of COVID-19 in PLWH, which appears to be similar to the general population. The pandemic has disrupted prevention and treatment of PLWH. However, there have been country efforts to counteract those effects. There are some lessons from the HIV response which have been effectively applied in the region to address COVID-19. COVID-19 has had an unprecedented impact on the cascade-of-care among PLWH in LAC. There is a need for longitudinal studies that assess clinic implication of these pandemic interactions in LAC.


Subject(s)
COVID-19 , HIV Infections , COVID-19/epidemiology , Caribbean Region/epidemiology , HIV Infections/prevention & control , Humans , Latin America/epidemiology , SARS-CoV-2
2.
Vaccine ; 40(13): 1977-1986, 2022 03 18.
Article in English | MEDLINE | ID: covidwho-1740256

ABSTRACT

In 2020, the World Health Organization launched the Immunization Agenda 2030: A Global Strategy to Leave No One Behind, which prioritizes high equitable immunization coverage at the national level and in all districts. Achieving high and homogenous immunization coverage, which is all the more important within the current context of the COVID-19 pandemic and vaccine rollout, requires the strengthening of existing immunization activities and innovative approach to immunization promotion. This research applied a descriptive case study methodology to document the implementation of strategic multi-level alliances to promote equitable immunization access and demand in Colombia, Guyana, and Sucre, Bolivia. Data collection, carried out between September 2019 and March 2020, included documentary reviews, semi-structured interviews, focus groups, and site visits accompanied by discussions with relevant stakeholders. Case studies provide valuable examples of people-centered, partnership-based, country-owned, and data-guided approaches to promoting equitable immunization coverage, including multi-level partnerships to build technical capacity for the identification and measurement of social inequalities impacting immunization in Colombia; intersectoral and community collaboration for pro-equity emergency response to regional vaccine preventable disease outbreaks in Guyana; and strategic alliances with the education sector and civil society organizations for the introduction of the human papilloma virus (HPV) vaccine in Sucre, Bolivia. Lessons learned highlight avenues for improving the impact of multi-level, equity-focused capacity building, particularly at the local level; optimizing the use of data and resources, partnerships, and community and stakeholder education and empowerment. While impact studies are needed to better understand the quantitative contributions of such strategic alliances, these case studies illustrate their practical significance and reinforce the value of multi-level, intersectoral collaboration for enhancing equitable immunization access and demand. The experiences of Colombia, Guyana, and Sucre, Bolivia provide evidence-based insight to support pro-equity immunization program planning to ensure that no one is left behind and that everyone, everywhere receives the benefits of vaccines, both routine and for COVID-19.


Subject(s)
COVID-19 Vaccines , COVID-19 , COVID-19/prevention & control , Caribbean Region , Humans , Immunization , Immunization Programs , Latin America , Pandemics/prevention & control
3.
J Environ Manage ; 309: 114698, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1693286

ABSTRACT

A literature review was carried out to analyze the current status of microplastic research in Latin America and the Caribbean (LAC). Specifically, this work focused on publications pertaining to (1) occurrence and distribution of microplastics in the environment, including water, sediments, and soil and (2) the environmental impact of MPs, particularly their presence and effects on aquatic and terrestrial organisms. The review included peer-reviewed articles from Scopus, Science Direct, Web of Science, Google Scholar and two iberoamerican open access databases (Redalyc and SciELO). It was found that LAC has only contributed to 5% of the global scientific output on microplastics, and overall the highest contributor within the region was Brazil (52%), followed by Chile (16%) and Mexico (13%). An additional section analyzing the barriers to conducting microplastic research in LAC and their exacerbation by the current COVID-19 pandemic was included to provide additional context behind the relatively low scientific production and improve recommendations encouraging research in this region.


Subject(s)
COVID-19 , Microplastics , Caribbean Region/epidemiology , Humans , Latin America/epidemiology , Pandemics , Plastics , SARS-CoV-2
4.
PLoS One ; 17(2): e0263981, 2022.
Article in English | MEDLINE | ID: covidwho-1690696

ABSTRACT

INTRODUCTION: The Coronavirus Disease 2019 (COVID19) pandemic has struck Latin America and the Caribbean (LAC) particularly hard. One of the crucial areas in the international community's response relates to accelerating research and knowledge sharing. The aim of this article is to map and characterise the existing empirical research related to COVID-19 in LAC countries and contribute to identify opportunities for strengthening future research. METHODS: In this scoping review, articles published between December 2019 and 11 November 2020 were selected if they included an empirical component (explicit scientific methods to collect and analyse primary data), LAC population was researched, and the research was about the COVID-19 pandemic, regardless of publication status or language. MEDLINE, EMBASE, LILACS, Scielo, CENTRAL and Epistemonikos were searched. All titles and abstracts, and full texts were screened by two independent reviewers. Data from included studies was extracted by one reviewer and checked by a second independent reviewer. RESULTS: 14,406 records were found. After removing duplicates, 5,458 titles and abstracts were screened, of which 2,323 full texts were revised to finally include 1,626 empirical studies. The largest portion of research came from people/population of Brazil (54.6%), Mexico (19.1%), Colombia (11.2%), Argentina (10.4%), Peru (10.3%) and Chile (10%), while Caribbean countries concentrated 15.3%. The methodologies most used were cross-sectional studies (34.7%), simulation models (17.5%) and randomized controlled trials (RCTs) (13.6%). Using a modified version of WHO's COVID-19 Coordinated Global Research Roadmap classification, 54.2% were epidemiological studies, followed by clinical management (22.3%) and candidate therapeutics (12.2%). Government and public funds support were reported in 19.2% of studies, followed by universities or research centres (9%), but 47.5% did not include any funding statement. CONCLUSION: During the first part of the COVID-19 pandemic, LAC countries have contributed to the global research effort primarily with epidemiological studies, with little participation on vaccines research, meaning that this type of knowledge would be imported from elsewhere. Research agendas could be further coordinated aiming to enhance shared self-sufficiency regarding knowledge needs in the region.


Subject(s)
COVID-19 , Empirical Research , Caribbean Region/epidemiology , Epidemiologic Studies , Humans , Latin America/epidemiology , Pandemics , SARS-CoV-2
5.
Curr Opin Pharmacol ; 63: 102203, 2022 04.
Article in English | MEDLINE | ID: covidwho-1676688

ABSTRACT

The COVID-19 pandemic has widespread economic and social effects on Latin America (LA) and the Caribbean (CA). This region, which has a high prevalence of chronic diseases, has been one of the most affected during the pandemic. Multiple symptoms and comorbidities are related to distinct COVID-19 outcomes. However, there has been no explanation as to why different patients present with different arrays of clinical presentations. Studies report that similar to comorbidities, each country in LA and the CA has its own particular health issues. Moreover, economic and social features have yet to be studied in detail to obtain a complete perspective of the disease in the region. Herein, the impact of demographic and economic characteristics in LA and the CA on COVID-19 are presented in combination with symptoms and comorbidities related to the disease as important aspects that can influence management and treatment.


Subject(s)
COVID-19 , COVID-19/epidemiology , Caribbean Region/epidemiology , Humans , Latin America/epidemiology , Morbidity , Pandemics
6.
Dent Med Probl ; 59(1): 5-11, 2022.
Article in English | MEDLINE | ID: covidwho-1662905

ABSTRACT

BACKGROUND: Dentistry is one of the professions that are most exposed to the contagion with coronavirus disease 2019 (COVID­19). However, the prevalence and positivity rates of COVID­19 are low in dentists, indicating that the current measures of infection control may be sufficient to prevent infection in dental settings. OBJECTIVES: The aim of the study was to determine whether the preventive measures for COVID­19 during the mandatory social isolation were followed by dental students and dentists in Latin America and the Caribbean in 2020. MATERIAL AND METHODS: A cross­sectional study was conducted using anonymous virtual surveys in a convenience sample of 2,036 dental students and dentists from 21 Latin American and Caribbean coun­ tries. The variables were the preventive measures for COVID­19 and the sociodemographic characteristics. Descriptive and bivariate analyses were performed. RESULTS: The final sample included 2,036 dental students and dentists. The self­perceived level of know­ ledge about COVID­19 was found to be associated with age, sex, body mass index (BMI), the type of aca­ demic training, having a specialty in the case of professionals, the place of origin, and having met someone with COVID­19 (p < 0.05). The self­perceived level of concern regarding COVID­19 was associated with sex, BMI and having met someone with COVID­19 (p < 0.05). The number of days in the mandatory social isolation was associated with age, the type of academic training, having a specialty, the place of origin, and having met someone with COVID­19 (p < 0.05). The confinement level was associated with age, sex, BMI, the type of academic training, and having met someone with COVID­19 (p < 0.05). Following the preven­ tive measures for COVID­19 was associated with age, the type of academic training, having a specialty, the place of origin, and having met someone with COVID­19 (p < 0.05). The use of face masks, hand washing and social distancing were associated with age, BMI, the type of academic training, the place of origin, and having met someone with COVID­19 (p < 0.05). CONCLUSIONS: Dental students and dentists followed the preventive measures for COVID­19 during the mandatory social isolation period in Latin America and the Caribbean in 2020.


Subject(s)
COVID-19 , COVID-19/prevention & control , Caribbean Region/epidemiology , Cross-Sectional Studies , Dentists , Humans , Latin America/epidemiology , Social Isolation , Students, Dental
9.
Food Nutr Bull ; 43(1): 84-103, 2022 03.
Article in English | MEDLINE | ID: covidwho-1571647

ABSTRACT

BACKGROUND: School feeding programs (SFPs) can play a crucial role in the emergency food and nutrition response, but there is a dearth of information on how SFPs operate during emergencies. DESIGN AND METHODS: A rapid comparative assessment of 11 SFPs throughout Latin America and the Caribbean during the COVID-19 pandemic. Data from (1) systematic document search and (2) surveys with key informants (n = 23) about barriers/facilitators to modifications were systematically analyzed using a multiple case study approach. RESULTS: During the pandemic, all SFPs continued (although continuation plans varied from a few days in Chile to > 1 month in Puerto Rico) via food kits, food vouchers, and/or grab n' go meals. The SFP implementation was highly dependent on the programs' autonomy and financial support, which impacted their logistics to acquire and distribute foods during the pandemic. The types of foods offered in some SFPs suggest that established nutritional guidelines were not always followed. Key informants expressed concerns about the deterioration of the nutritional quality of foods offered during the pandemic and lack of community engagement that impeded distribution to the neediest. CONCLUSIONS: Results underscore the urgency for clear implementation guidance on how to modify SFP during emergencies. Public health implications include (1) allocation of autonomous resources to an intersectoral working group to safeguard nutritional benefits during emergencies, (2) strengthening efforts of SFP community engagement before and during emergencies, and (3) establishing guidelines of the types of foods that can be distributed to meet the nutritional needs of beneficiaries during emergencies.


Subject(s)
COVID-19 , Pandemics , Caribbean Region , Humans , Latin America/epidemiology , Pandemics/prevention & control , SARS-CoV-2 , Schools
10.
Public Health Res Pract ; 31(4)2021 Nov 10.
Article in English | MEDLINE | ID: covidwho-1524687

ABSTRACT

Objectives and importance of study: The importance of health policy and systems research (HPSR) has been acknowledged since 2004 and was recognised by the United Nations World Health Assembly in 2005. However, many factors influence its development. This paper aims to analyse the impact of politics and political determinants on HPSR funding in selected countries of Latin America and the Caribbean. METHODS: Using a standardised protocol, we performed an analysis of available data and financing structures for health research and HPSR, based on research in eight countries, including interviews with key stakeholders (n = 42). RESULTS: Dollar depreciation and gross national product growth in the region may play a role in how governments fund research. There have been shifts in the political spectrum in governments, which have affected research coordination and funding in positive and negative ways. HPSR funding in some countries was dependent on budget decisions and although some have improved funding, others have regressed by decreasing funding or have completely cancelled financing mechanisms. Caribbean countries rely mainly on institutional funding. HPSR is recognised as important but remains underfunded; stakeholders believed it should be used more in decision making. CONCLUSION: Although HPSR is recognised as valuable for decision making and policy development, it does not have the financial support required to flourish in Latin America and the Carribean. Data on health research financing were not easy to access. There was little or no evidence of published reports or papers about research financing, health research funding, and HPSR funding in particular in the studied countries. Because of the fragility of health systems highlighted by the coronavirus disease 2019 (COVID-19) pandemic, HPSR should be of great relevance and value to both policy makers and funders.


Subject(s)
COVID-19 , Health Policy , Caribbean Region , Health Services Research , Humans , Latin America , Politics , SARS-CoV-2
11.
Int J Environ Res Public Health ; 18(21)2021 11 08.
Article in English | MEDLINE | ID: covidwho-1512316

ABSTRACT

COVID-19 has had a severe impact on human health, as well as in social and economic terms, with implications for the management and governance of the water and sanitation sector. These implications are evident in Latin America and the Caribbean due to existing challenges the region faces in accessing water and sanitation services. In spite of significant advances, around 65 million people in the LAC region currently lack appropriate access to water and soap to wash their hands-one of the most basic measures to prevent the spread of disease. Furthermore, social and economic vulnerabilities have exacerbated the effects of the pandemic in the region, particularly among those living in poverty. The COVID-19 pandemic thus requires the mobilization of frameworks such as the human rights to water and sanitation, specifically considering the region's realities. This paper provides a review of some of the challenges currently faced in the region and advances a series of recommendations for enhancing access to water, sanitation and hygiene. The importance of effective governance, management and communication strategies in the water provisioning sector is highlighted in the context of the pandemic, and the role of science and research for adequate decision making is emphasized.


Subject(s)
COVID-19 , Sanitation , Caribbean Region , Humans , Latin America , Pandemics , SARS-CoV-2 , Water , Water Supply
12.
Cad. Saúde Pública (Online) ; 37(10): e00270720, 2021. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1502130

ABSTRACT

Infodemiology has been widely used to assess epidemics. In light of the recent pandemic, we use Google Search data to explore online interest about COVID-19 and related topics in 20 countries of Latin America and the Caribbean. Data from Google Trends from December 12, 2019, to April 25, 2020, regarding COVID-19 and other related topics were retrieved and correlated with official data on COVID-19 cases and with national epidemiological indicators. The Latin American and Caribbean countries with the most interest for COVID-19 were Peru (100%) and Panama (98.39%). No correlation was found between this interest and national epidemiological indicators. The global and local response time were 20.2 ± 1.2 days and 16.7 ± 15 days, respectively. The duration of public attention was 64.8 ± 12.5 days. The most popular topics related to COVID-19 were: the country's situation (100 ± 0) and coronavirus symptoms (36.82 ± 16.16). Most countries showed a strong or moderated (r = 0.72) significant correlation between searches related to COVID-19 and daily new cases. In addition, the highest significant lag correlation was found on day 13.35 ± 5.76 (r = 0.79). Interest shown by Latin American and Caribbean countries for COVID-19 was high. The degree of online interest in a country does not clearly reflect the magnitude of their epidemiological indicators. The response time and the lag correlation were greater than in European and Asian countries. Less interest was found for preventive measures. Strong correlation between searches for COVID-19 and daily new cases suggests a predictive utility.


La infodemiología ha sido utilizada ampliamente para evaluar epidemias. A la luz de la pandemia reciente, usamos datos de Google Search para investigar el interés en línea sobre COVID-19 y temas relacionados en 20 países de Latinoamérica y el Caribe. Los datos se obtuvieron de Google Trends, desde el 12 de diciembre 2019 al 25 de abril de 2020, respecto a la COVID-19 y otros temas relacionados, y se correlacionaron con datos oficiales sobre casos de COVID-19, así como con indicadores nacionales epidemiológicos. Los países latinoamericanos y del Caribe con mayor interés en la COVID-19 fueron: Perú (100%) y Panamá (98,39%). No se encontró correlación entre este interés y los indicadores nacionales epidemiológicos. Los tiempos de respuesta global y local fueron 20,2 ± 1,2 días and 16,7 ± 15 días, respectivamente. La duración de la atención pública fue 64,8 ± 12,5 días. Los temas más populares relacionados con la COVID-19 fueron: la situación del país (100 ± 0) y síntomas de coronavirus (36,82 ± 16,16). La mayoría de los países mostraron una correlación significativa fuerte o moderada (r = 0,72) entre las búsquedas relacionadas con la COVID-19 y los nuevos casos diarios. Asimismo, se descubrió que la correlación de retraso significativa más alta se produjo el día 13,35 ± 5,76 (r = 0,79). El interés mostrado por países latinoamericanos y del Caribe sobre la COVID-19 fue alto. El grado de interés en línea en un país no refleja claramente la magnitud de sus indicadores epidemiológicos. El tiempo de respuesta y la correlación de retraso fueron mayores que en los países europeos y asiáticos. Se descubrió poco interés respecto a las medidas preventivas. Una fuerte correlación entre las búsquedas de COVID-19 y nuevos casos diarios sugiere una utilidad predictiva.


A infodemiologia tem sido largamente utilizada para avaliar as epidemias. À luz da mais recente pandemia, utilizamos dados da Google Search para explorar o interesse online sobre COVID-19 e temas correlatos em 20 países da América Latina e Caribe. Foram recuperados e correlacionados dados do Google Trends entre 12 de dezembro de 2019 e 25 de abril de 2020, sobre COVID-19 e temas relacionados, com dados oficiais sobre casos de COVID-19 e com indicadores epidemiológicos nacionais. Os países latino-americanos e caribenhos com maior interesse na COVID-19 foram Peru (100%) e Panamá (98.39%). Não foi encontrada correlação entre esse interesse e os indicadores epidemiológicos nacionais. Os tempos de resposta global e local foram de 20,2 ± 1,2 dias e 16,7 ± 15 dias, respectivamente. A duração da atenção do público foi de 64,8 ± 12,5 dias. Os temas mais populares relacionados à COVID-19 foram: a situação do respectivo país (100 ± 0) e os sintomas relacionados ao novo coronavírus (36,82 ± 16,16). A maioria dos países mostrou uma associação significativa forte ou moderada (r = 0,72) entre buscas relacionadas à COVID-19 e casos novos diários. Além disso, a correlação defasada significativa mais alta foi encontrada no dia 13,35 ± 5,76 (r = 0,79). Os países latino-americanos e caribenhos demonstraram forte interesse na COVID-19. O grau de interesse na internet em um país não reflete claramente a magnitude de seus indicadores epidemiológicos. O tempo de resposta e a correlação defasada foram maiores que nos países europeus e asiáticos. Houve pouco interesse em medidas preventivas. A correlação forte entre busca por COVID-19 e casos novos diários sugere utilidade preditiva.


Subject(s)
Humans , COVID-19 , Brazil , Caribbean Region , Search Engine , Pandemics , SARS-CoV-2 , Latin America/epidemiology
13.
HIV Med ; 23(2): 169-177, 2022 02.
Article in English | MEDLINE | ID: covidwho-1462791

ABSTRACT

OBJECTIVES: The coronavirus disease (COVID-19) pandemic has been associated with severe disruptions in health care services, and nonpharmacological measures such as social distancing also have an impact on access to screening tests and on the long-term care of patients with chronic conditions globally. We aimed to describe the impact of the COVID-19 pandemic on HIV testing and treatment and to describe strategies employed to mitigate the impact of COVID-19 on HIV care. METHODS: In this retrospective cohort study, we used secondary data from the AIDS Healthcare Foundation (AHF) Global Quality Program from 44 countries in four continents (Asia, Latin America and the Caribbean, Europe and Africa), and compared information on HIV testing, percentage of positive results, number of in-person appointments, and number of new enrolments in HIV care from 1 January 2020 to 31 August 2020 with the equivalent period in 2019. RESULTS: Despite marked inter-country heterogeneities, we found that COVID-19 was associated with a significant reduction in HIV testing, an increase in the percentage of positive tests, a reduction in the number of in-person consultations and a reduction in the number of new enrolments in care, despite the implementation of several mitigation strategies. The impact of COVID-19 differed across continents and key populations. CONCLUSIONS: Our findings suggest that, in the years to come, health care services must be prepared to respond to the impact of COVID-19 on HIV testing and care. Providers and facilities should build on the lessons learned so far to further improve mitigation strategies and establish care priorities for both the pandemic and the post-pandemic periods.


Subject(s)
COVID-19 , HIV Infections , HIV Testing , Pandemics , Africa/epidemiology , Asia/epidemiology , COVID-19/epidemiology , Caribbean Region/epidemiology , Europe/epidemiology , HIV Infections/diagnosis , HIV Infections/therapy , HIV Testing/statistics & numerical data , Humans , Latin America/epidemiology , Retrospective Studies
15.
Leadersh Health Serv (Bradf Engl) ; ahead-of-print(ahead-of-print)2021 08 04.
Article in English | MEDLINE | ID: covidwho-1379508

ABSTRACT

PURPOSE: Nurses are a significant part of the professional workforce, but leaders may be promoted without the requisite competencies. This study aims to explore the perspectives of nurse managers about the core competencies necessary for promotion as leaders in health. DESIGN/METHODOLOGY/APPROACH: This was a mixed-methods study that targeted nurses (N = 126) who were promoted in four Caribbean countries over the past five years. A 30-item questionnaire was used for quantitative data collection and analyzed using SPSS version 25. Interviews yielded the qualitative data, which were analyzed using open coding and thematic analysis. Ethical approvals were received from ethics committees at the university and country level. FINDINGS: Most participants were female (n = 112), had 15 or more years' experience (n = 71) and an associate degree/diploma in nursing (n = 62). Leadership was the most important competency required of nurse leaders in spite of their position within the organization, followed by team building and motivation. Challenges to the transitioning into leadership positions included the prevailing culture and a lack of a systematic approach to building capacity in leadership. There was also between-group statistical significance, as determined by one-way ANOVA for delegation, motivation and leadership as core competencies based on occupations roles. RESEARCH LIMITATIONS/IMPLICATIONS: Notwithstanding the importance of the findings from this research, there were some limitations. While the researchers considered implementing this study in eight Caribbean countries, approvals were received for only four countries. This will affect the ability to generalize the findings to the wider Caribbean countries. One of the strengths of this research was the use of mixed methods for data collection. However, the qualitative component of the findings may be limited by the number of focus groups conducted, notwithstanding the richness of the data collected. PRACTICAL IMPLICATIONS: The findings can be used as a framework from which the health system in developing countries can begin to examine practical solutions to developing 21st century leadership competencies in nursing. While there may be remanence of the colonial past in the way systems function, the complexity of health systems requires leadership that is rooted in competence that is multidimensional. ORIGINALITY/VALUE: This paper provides an important contribution to the literature on leadership and competencies from the perspective of low- to middle-income resource settings. The qualitative component of the research added richness to the nuances and understanding of the phenomenon of competencies for nurse leaders.


Subject(s)
Leadership , Nurse Administrators , Caribbean Region , Female , Humans
16.
Travel Med Infect Dis ; 41: 102059, 2021.
Article in English | MEDLINE | ID: covidwho-1371543

ABSTRACT

BACKGROUND: Determinants of vaccine acceptance are multifactorial, complex, and in most cases, context-dependent. We determined the prevalence of COVID-19 vaccination intention (VI) and fear of its adverse effects (FAE) as well as their associated factors in Latin America and the Caribbean (LAC). METHODS: We conducted a secondary cross-sectional analysis of a database collected by the University of Maryland and Facebook. We included participants aged 18 and over from LAC surveyed, January 15 to February 1, 2021. We evaluated VI, FAE, sociodemographic characteristics, COVID-19 symptomatology, compliance with community mitigation strategies, food and economic insecurity, mental health evaluation and the influence in VI when recommended by different stakeholders. We calculated crude and adjusted prevalence ratios with their 95%CIs. RESULTS: We analyzed 472,521 responses by Latin American adults, finding a VI and FAE prevalence of 80.0% and 81.2%, respectively. We found that female and non-binary genders were associated with a lower probability of VI and a higher probability of FAE. Besides, living in a town, village or rural area and economic insecurity was associated with a higher FAE probability. The fears of becoming seriously ill, a family member becoming seriously ill from COVID-19 and having depressive symptoms were associated with a higher probability of VI and FAE. CONCLUSION: Eight out of 10 adults in LAC have VI and FAE. The factors identified are useful for the development of communication strategies to reduce FAE frequency. It is necessary to guarantee mass vaccination and support the return of economic activities.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Vaccination/psychology , Vaccination/statistics & numerical data , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/psychology , Caribbean Region/epidemiology , Cross-Sectional Studies , Female , Humans , Intention , Latin America/epidemiology , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Perception , SARS-CoV-2 , Surveys and Questionnaires , Vaccination Refusal/statistics & numerical data , Young Adult
17.
BMJ Open ; 11(8): e047779, 2021 08 19.
Article in English | MEDLINE | ID: covidwho-1367438

ABSTRACT

OBJECTIVES: Latin America and the Caribbean (LAC) countries have made important progress towards achieving the Sustainable Development Goal (SDG) targets related to health (SDG3) at the national level. However, vast within-country health inequalities remain. We present a baseline of health inequalities in the region, against which progress towards the SDGs can be monitored. SETTING: We studied 21 countries in LAC using data from Demographic and Health Surveys and Multiple Indicator Cluster Survey carried out from 2011 to 2016 PARTICIPANTS: The surveys collect nationally representative data on women and children using multistage sampling. In total, 288 207 women and 195 092 children made part of the surveys in the 21 countries. OUTCOME MEASURES: Five health intervention indicators were studied, related to reproductive and maternal health, along with adolescent fertility and neonatal and under-five mortality rates. Inequalities in these indicators were assessed through absolute and relative measures. RESULTS: In most countries, subnational geographical health gradients were observed for nearly all women, child, and adolescent (WCA) indicators. Coverage of key interventions was higher in urban areas and among the richest, compared with rural areas and poorer quintiles. Analyses by woman's age showed that coverage was lower in adolescent girls than older women for family planning indicators. Pro-urban and pro-rich inequalities were also seen for mortality in most countries. CONCLUSIONS: Regional averages hide important health inequalities between countries, but national estimates hide still greater inequalities between subgroups of women, children and adolescents. To achieve the SDG3 targets and leave no one behind, it is essential to close health inequality gaps within as well as between countries.


Subject(s)
Health Status Disparities , Sustainable Development , Adolescent , Aged , Caribbean Region , Child , Cross-Sectional Studies , Female , Healthcare Disparities , Humans , Infant, Newborn , Latin America/epidemiology , Socioeconomic Factors
18.
Am J Obstet Gynecol ; 226(2): 236.e1-236.e14, 2022 02.
Article in English | MEDLINE | ID: covidwho-1347471

ABSTRACT

BACKGROUND: Concerns have been raised regarding a potential surge of COVID-19 in pregnancy, secondary to the rising numbers of COVID-19 in the community, easing of societal restrictions, and vaccine hesitancy. Although COVID-19 vaccination is now offered to all pregnant women in the United Kingdom; limited data exist on its uptake and safety. OBJECTIVE: This study aimed to investigate the uptake and safety of COVID-19 vaccination among pregnant women. STUDY DESIGN: This was a cohort study of pregnant women who gave birth at St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom, between March 1, 2020, and July 4, 2021. The primary outcome was uptake of COVID-19 vaccination and its determinants. The secondary outcomes were perinatal safety outcomes. Data were collected on COVID-19 vaccination uptake, vaccination type, gestational age at vaccination, and maternal characteristics, including age, parity, ethnicity, index of multiple deprivation score, and comorbidities. Further data were collected on perinatal outcomes, including stillbirth (fetal death at ≥24 weeks' gestation), preterm birth, fetal and congenital abnormalities, and intrapartum complications. Pregnancy and neonatal outcomes of women who received the vaccine were compared with that of a matched cohort of women with balanced propensity scores. Effect magnitudes of vaccination on perinatal outcomes were reported as mean differences or odds ratios with 95% confidence intervals. Factors associated with antenatal vaccination were assessed with logistic regression analysis. RESULTS: Data were available for 1328 pregnant women of whom 140 received at least 1 dose of the COVID-19 vaccine before giving birth and 1188 women who did not; 85.7% of those vaccinated received their vaccine in the third trimester of pregnancy and 14.3% in the second trimester of pregnancy. Of those vaccinated, 127 (90.7%) received a messenger RNA vaccine and 13 (9.3%) a viral vector vaccine. There was evidence of reduced vaccine uptake in younger women (P=.001), women with high levels of deprivation (ie, fifth quintile of the index of multiple deprivation; P=.008), and women of Afro-Caribbean or Asian ethnicity compared with women of White ethnicity (P<.001). Women with prepregnancy diabetes mellitus had increased vaccine uptake (P=.008). In the multivariable model the fifth deprivation quintile (most deprived) (adjusted odds ratio, 0.10; 95% confidence interval, 0.02-0.10; P=.003) and Afro-Caribbean ethnicity (adjusted odds ratio, 0.27; 95% confidence interval, 0.06-0.85; P=.044) were significantly associated with lower antenatal vaccine uptake, whereas prepregnancy diabetes mellitus was significantly associated with higher antenatal vaccine uptake (adjusted odds ratio, 10.5; 95% confidence interval, 1.74-83.2; P=.014). In a propensity score-matched cohort, the rates of adverse pregnancy outcomes of 133 women who received at least 1 dose of the COVID-19 vaccine in pregnancy were similar to that of unvaccinated pregnant women (P>.05 for all): stillbirth (0.0% vs 0.2%), fetal abnormalities (2.2% vs 2.5%), postpartum hemorrhage (9.8% vs 9.0%), cesarean delivery (30.8% vs 34.1%), small for gestational age (12.0% vs 12.8%), maternal high-dependency unit or intensive care admission (6.0% vs 4.0%), or neonatal intensive care unit admission (5.3% vs 5.0%). Intrapartum pyrexia (3.7% vs 1.0%; P=.046) was significantly increased but the borderline statistical significance was lost after excluding women with antenatal COVID-19 infection (P=.079). Mixed-effects Cox regression showed that vaccination was not significantly associated with birth at <40 weeks' gestation (hazard ratio, 0.93; 95% confidence interval, 0.71-1.23; P=.624). CONCLUSION: Of pregnant women eligible for COVID-19 vaccination, less than one-third accepted COVID-19 vaccination during pregnancy, and they experienced similar pregnancy outcomes with unvaccinated pregnant women. There was lower uptake among younger women, non-White ethnicity, and lower socioeconomic background. This study has contributed to the body of evidence that having COVID-19 vaccination in pregnancy does not alter perinatal outcomes. Clear communication to improve awareness among pregnant women and healthcare professionals on vaccine safety is needed, alongside strategies to address vaccine hesitancy. These strategies include postvaccination surveillance to gather further data on pregnancy outcomes, particularly after first-trimester vaccination, and long-term infant follow-up.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Pregnancy Complications, Infectious/prevention & control , Vaccination Coverage/statistics & numerical data , /therapeutic use , Adult , Age Factors , Caribbean Region , Case-Control Studies , Cesarean Section/statistics & numerical data , Congenital Abnormalities/epidemiology , Female , Fever/epidemiology , Humans , Infant, Small for Gestational Age , Intensive Care Units , Intensive Care Units, Neonatal , Logistic Models , Obstetric Labor Complications/epidemiology , Postpartum Hemorrhage/epidemiology , Pregnancy , Premature Birth/epidemiology , Propensity Score , Proportional Hazards Models , SARS-CoV-2 , Social Determinants of Health , Stillbirth/epidemiology , United Kingdom/epidemiology
19.
Int J Environ Res Public Health ; 18(15)2021 07 29.
Article in English | MEDLINE | ID: covidwho-1335057

ABSTRACT

The objective of this meta-analysis was to evaluate the factors associated with the mortality of elderly Italians diagnosed with coronavirus who resided in institutions or who were hospitalized because of the disease. METHODS: A systematic review following the recommendations of The Joanna Briggs Institute (JBI) was carried out, utilizing the PEO strategy, i.e., Population, Exposure and Outcome. In this case, the population was the elderly aged over 65 years old, the exposure referred to the SARS-CoV-2 pandemic and the outcome was mortality. The National Center for Biotechnology Information (NCBI/PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), Excerpta Medica Database (EMBASE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were used until 31 July 2020. RESULTS: Five Italian studies were included in this meta-analysis, with the number of elderly people included varying between 18 and 1591 patients. The main morbidities presented by the elderly in the studies were dementia, diabetes, chronic kidney disease and hypertension. CONCLUSIONS: The factors associated with the mortality of elderly Italian people diagnosed with SARS-CoV-2 who lived in institutions or who were hospitalized because of the disease were evaluated. It was found that dementia, diabetes, chronic kidney disease and hypertension were the main diagnosed diseases for mortality in elderly people with COVID-19.


Subject(s)
COVID-19 , Hypertension , Aged , Caribbean Region , Humans , Pandemics , SARS-CoV-2
20.
Clin Infect Dis ; 73(1): e215-e223, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1291317

ABSTRACT

BACKGROUND: As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic continues its rapid global spread, quantification of local transmission patterns has been, and will continue to be, critical for guiding the pandemic response. Understanding the accuracy and limitations of statistical methods to estimate the basic reproduction number, R0, in the context of emerging epidemics is therefore vital to ensure appropriate interpretation of results and the subsequent implications for control efforts. METHODS: Using simulated epidemic data, we assess the performance of 7 commonly used statistical methods to estimate R0 as they would be applied in a real-time outbreak analysis scenario: fitting to an increasing number of data points over time and with varying levels of random noise in the data. Method comparison was also conducted on empirical outbreak data, using Zika surveillance data from the 2015-2016 epidemic in Latin America and the Caribbean. RESULTS: We find that most methods considered here frequently overestimate R0 in the early stages of epidemic growth on simulated data, the magnitude of which decreases when fitted to an increasing number of time points. This trend of decreasing bias over time can easily lead to incorrect conclusions about the course of the epidemic or the need for control efforts. CONCLUSIONS: We show that true changes in pathogen transmissibility can be difficult to disentangle from changes in methodological accuracy and precision in the early stages of epidemic growth, particularly for data with significant over-dispersion. As localized epidemics of SARS-CoV-2 take hold around the globe, awareness of this trend will be important for appropriately cautious interpretation of results and subsequent guidance for control efforts.


Subject(s)
COVID-19 , Epidemics , Zika Virus Infection , Zika Virus , Basic Reproduction Number , Caribbean Region , Humans , Pandemics , Reproduction , SARS-CoV-2
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