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2.
J Gerontol B Psychol Sci Soc Sci ; 76(7): e268-e274, 2021 08 13.
Article in English | MEDLINE | ID: covidwho-1526159

ABSTRACT

OBJECTIVES: Mexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities. METHOD: We linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator. RESULTS: Older adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0-1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5-576.7). DISCUSSION: Urgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility/statistics & numerical data , Health Status Disparities , Poverty/statistics & numerical data , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Age Factors , Aged , COVID-19/therapy , Female , Humans , Male , Mexico/epidemiology , Rural Health Services/organization & administration , Urban Health Services/organization & administration
3.
J Infect Dev Ctries ; 15(10): 1388-1395, 2021 10 31.
Article in English | MEDLINE | ID: covidwho-1518654

ABSTRACT

INTRODUCTION: Immunization, as a process of fighting against the COVID-19, has gained important research appeal, but very limited endeavor has been paid for vaccine behavioral studies in underdeveloped and developing countries. This study explores the vaccine demand, hesitancy, and nationalism as well as vaccine acceptance and domestic vaccine preference among young adults in Bangladesh. METHODOLOGY: This quantitative study followed the snowball sampling technique and collected responses from 1,018 individuals from various social media platforms. The analysis covered both descriptive and inferential statistics including chi-square, F-statistic, and logistic regression. RESULTS: The findings of the fully-adjusted regression model suggest that the individuals who had more vaccine demand were 3.29 times (95% confidence interval = 2.39-4.54; p < 0.001) higher to accept vaccine compared to those who had no vaccine demand. Conversely, vaccine hesitancy was negatively associated with vaccine acceptance. Here, the odds ratio was found 0.70 (95% confidence interval = 0.62-0.80; p < 0.001), which means that those who had higher vaccine hesitancy were about 30% less likely to accept vaccines than those who had no hesitancy. In addition, the persons who had vaccine nationalism were 1.75 times (95% confidence interval = 1.62-1.88; p < 0.001) more prone to prefer domestic vaccine. CONCLUSIONS: This study suggests that policymakers may take initiatives for making people aware and knowledgeable about the severity and vulnerability to specific health threats. In this concern, perception and efficacy-increasing programs may take part in increasing protection motivation behaviors like vaccine acceptance and (domestic) vaccine preference.


Subject(s)
Attitude to Health , COVID-19 Vaccines/administration & dosage , Health Knowledge, Attitudes, Practice , Motivation , Patient Acceptance of Health Care , Vaccination/psychology , Adolescent , Bangladesh , Cross-Sectional Studies , Female , Humans , Male , Rural Population/statistics & numerical data , SARS-CoV-2/pathogenicity , Surveys and Questionnaires , Urban Population/statistics & numerical data , Vaccination Refusal/psychology , Young Adult
4.
Nutrients ; 13(10)2021 Oct 09.
Article in English | MEDLINE | ID: covidwho-1463779

ABSTRACT

The COVID-19 pandemic has caused disruption to food security in many countries, including Kenya. However, the impact of this on food provision to children at an individual level is unknown. This small study aimed to provide a qualitative snapshot of the diets of children during the COVID-19 pandemic. During completion of 24-h food recalls, with 15 families with children aged 5-8 years, caregivers were asked about changes they had made to foods given to their children due to the pandemic. Food recalls were analysed to assess nutrient intakes. Qualitative comments were thematically analysed. Most of the families reported making some changes to foods they provided to their children due to COVID-19. Reasons for these changes fell into three themes, inability to access foods (both due to formal restriction of movements and fear of leaving the house), poorer availability of foods, and financial constraints (both decreases in income and increases in food prices). The COVID-19 pandemic has affected some foods parents in rural Kenya can provide to their children.


Subject(s)
COVID-19 , Diet/methods , Eating , Food Supply/methods , Food Supply/statistics & numerical data , Rural Population/statistics & numerical data , Child , Child, Preschool , Evaluation Studies as Topic , Female , Humans , Income , Kenya , Male , Pandemics , SARS-CoV-2
5.
Elife ; 102021 09 17.
Article in English | MEDLINE | ID: covidwho-1438866

ABSTRACT

Human mobility is a core component of human behavior and its quantification is critical for understanding its impact on infectious disease transmission, traffic forecasting, access to resources and care, intervention strategies, and migratory flows. When mobility data are limited, spatial interaction models have been widely used to estimate human travel, but have not been extensively validated in low- and middle-income settings. Geographic, sociodemographic, and infrastructure differences may impact the ability for models to capture these patterns, particularly in rural settings. Here, we analyzed mobility patterns inferred from mobile phone data in four Sub-Saharan African countries to investigate the ability for variants on gravity and radiation models to estimate travel. Adjusting the gravity model such that parameters were fit to different trip types, including travel between more or less populated areas and/or different regions, improved model fit in all four countries. This suggests that alternative models may be more useful in these settings and better able to capture the range of mobility patterns observed.


Subject(s)
Human Migration/statistics & numerical data , Models, Biological , Rural Population/statistics & numerical data , Africa South of the Sahara/epidemiology , Humans , Spatial Analysis , Travel/statistics & numerical data
6.
Int J Equity Health ; 20(1): 203, 2021 09 08.
Article in English | MEDLINE | ID: covidwho-1430428

ABSTRACT

BACKGROUND: To address the challenge of the aging population, community-based care services (CBCS) have been developed rapidly in China as a new way of satisfying the needs of elderly people. Few studies have described the evolution trend of availability of CBCS in rural and urban areas and evaluated their effectiveness. This study aims to show the availability of China's CBCS and further analyze the effect of the CBCS on the cognitive function of elderly people. METHODS: Longitudinal analysis was performed using data from the 2008 to 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 23937 observations from 8421 elderly people were included in the study. The Chinese version of the Mini-Mental State Examination (MMSE) was used to assess cognitive function. We aggregated similar CBCS to generate three binary variable categories (daily life support, emotional comfort and entertainment services, medical support and health services) indicating the availability of CBCS (1 = yes, 0 = no). Multilevel growth models were employed to estimate the association between CBCS and cognitive function while adjusting for many demographic and socioeconomic characteristics. RESULTS: The availability of CBCS increased a lot from 2008 to 2018 in China. Although the availability of CBCS in urban areas was higher than that in rural areas in 2008, by 2018 the gap narrowed significantly. Emotional comfort and entertainment services (B = 0.331, 95% CI = 0.090 to 0.572) and medical support and health services (B = 1.041, 95% CI = 0.854 to 1.228) were significantly and positively associated with cognitive function after adjusting for the covariates. CONCLUSION: There was a significant increase in the availability of CBCS from 2008 to 2018 in China. This study sheds light on the positive correlation between CBCS and cognitive function among Chinese elderly individuals. The results suggest that policymakers should pay more attention to the development of CBCS and the equity of the supply of CBCS in urban and rural areas.


Subject(s)
Cognition , Community Health Services , Aged , Aged, 80 and over , China , Cognition/physiology , Community Health Services/supply & distribution , Female , Humans , Longitudinal Studies , Male , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data
7.
Sci Rep ; 11(1): 18474, 2021 09 16.
Article in English | MEDLINE | ID: covidwho-1415959

ABSTRACT

Understanding patient progression from symptomatic COVID-19 infection to a severe outcome represents an important tool for improved diagnoses, surveillance, and triage. A series of models have been developed and validated to elucidate hospitalization, admission to an intensive care unit (ICU) and mortality in patients from the Republic of Ireland. This retrospective cohort study of patients with laboratory-confirmed symptomatic COVID-19 infection included data extracted from national COVID-19 surveillance forms (i.e., age, gender, underlying health conditions, occupation) and geographically-referenced potential predictors (i.e., urban/rural classification, socio-economic profile). Generalised linear models and recursive partitioning and regression trees were used to elucidate COVID-19 progression. The incidence of symptomatic infection over the study-period was 0.96% (n = 47,265), of whom 3781 (8%) required hospitalisation, 615 (1.3%) were admitted to ICU and 1326 (2.8%) died. Models demonstrated an increasingly efficacious fit for predicting hospitalization [AUC 0.816 (95% CI 0.809, 0.822)], admission to ICU [AUC 0.885 (95% CI 0.88 0.89)] and death [AUC of 0.955 (95% CI 0.951 0.959)]. Severe obesity (BMI ≥ 40) was identified as a risk factor across all prognostic models; severely obese patients were substantially more likely to receive ICU treatment [OR 19.630] or die [OR 10.802]. Rural living was associated with an increased risk of hospitalization (OR 1.200 (95% CI 1.143-1.261)]. Urban living was associated with ICU admission [OR 1.533 (95% CI 1.606-1.682)]. Models provide approaches for predicting COVID-19 prognoses, allowing for evidence-based decision-making pertaining to targeted non-pharmaceutical interventions, risk-based vaccination priorities and improved patient triage.


Subject(s)
COVID-19/epidemiology , Obesity, Morbid/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Comorbidity , Evidence-Based Medicine , Female , Hospital Mortality , Hospitalization , Humans , Incidence , Intensive Care Units , Ireland/epidemiology , Linear Models , Male , Middle Aged , Population Surveillance , Prognosis , Retrospective Studies , Rural Population/statistics & numerical data , Socioeconomic Factors , Urban Population/statistics & numerical data
8.
PLoS One ; 16(8): e0256113, 2021.
Article in English | MEDLINE | ID: covidwho-1357438

ABSTRACT

BACKGROUND: Separating ill or possibly infectious people from their healthy community is one of the core principles of non-pharmaceutical interventions. However, there is scarce evidence on how to successfully implement quarantine orders. We investigated a community quarantine for an entire village in Germany (Neustadt am Rennsteig, March 2020) with the aim of better understanding the successful implementation of quarantine measures. METHODS: This cross-sectional survey was conducted in Neustadt am Rennsteig six weeks after the end of a 14-day mandatory community quarantine. The sample size consisted of 562 adults (64% of the community), and the response rate was 295 adults, or 52% (33% of the community). FINDINGS: National television was reported as the most important channel of information. Contact with local authorities was very limited, and partners or spouses played a more important role in sharing information. Generally, the self-reported information level was judged to be good (211/289 [73.0%]). The majority of participants (212/289 [73.4%]) approved of the quarantine, and the reported compliance was 217/289 (75.1%). A self-reported higher level of concern as well as a higher level of information correlated positively with both a greater acceptance of quarantine and self-reported compliant behaviour. INTERPRETATION: The community quarantine presented a rare opportunity to investigate a public health intervention for an entire community. In order to improve the implementation of public health interventions, public health risk communication activities should be intensified to increase both the information level (potentially leading to better compliance with community quarantine) and the communication level (to facilitate rapport and trust between public health authorities and their communities).


Subject(s)
COVID-19/prevention & control , Communication , Health Knowledge, Attitudes, Practice , Quarantine/psychology , Adult , Aged , COVID-19/psychology , Community-Institutional Relations , Female , Germany , Humans , Male , Middle Aged , Rural Population/statistics & numerical data
9.
Med Sci Monit ; 27: e928512, 2021 Sep 13.
Article in English | MEDLINE | ID: covidwho-1355250

ABSTRACT

BACKGROUND Coronavirus disease 2019 (COVID-19) has emerged as a global threat. This study was performed to gain an understanding of COVID-19-related knowledge, attitudes, and practices among susceptible individuals. MATERIAL AND METHODS Patients who had been diagnosed with old myocardial infarction were followed up via telephone survey based on an established follow-up system at the beginning of the COVID-19 outbreak (January 2020) in Chongqing, Southwest China. RESULTS A total of 631 eligible patients participated in this survey, and 40.6% of the rural respondents did not know the transmission routes of SARS-CoV-2, which was higher than the proportion of urban respondents (40.6% vs 31.0). Rural residents had a lower rate of adopting preventive measures than urban residents, such as wearing masks (76.7% vs 90.1%), avoiding meetings and gatherings (58.6% vs 68.5%), and hand washing (56.0% vs 63.8%). A higher percentage of women than men did not take any preventive measures (11.3% vs 7.6%), while a lower percentage of women than men wore masks (77.7% vs 84.5%). Multiple logistic regression revealed that rural patients were more likely to lack knowledge about transmission (odds ratio (OR): 1.51). Rural patients had an increased risk of failing to implement protective measures. CONCLUSIONS Female and rural populations lacked knowledge and failed to adopt protective measures during the beginning of the COVID-19 epidemic. Therefore, these populations may benefit from health education campaigns and policies.


Subject(s)
COVID-19 , Health Knowledge, Attitudes, Practice , Adult , Aged , China , Female , Health Behavior , Humans , Male , Middle Aged , Myocardial Infarction , Rural Population/statistics & numerical data , SARS-CoV-2
11.
S Afr Fam Pract (2004) ; 63(1): e1-e5, 2021 07 19.
Article in English | MEDLINE | ID: covidwho-1339652

ABSTRACT

People with disabilities, especially those living in low- and middle-income countries, experience significant challenges in accessing healthcare services and support. At times of disasters and emergencies, people with disabilities are further marginalised and excluded. During the coronavirus disease 2019 (COVID-19) pandemic, many people with disabilities are unable to access healthcare facilities, receive therapeutic interventions or rehabilitation, or gain access to medication. Of those who are able to access facilities, many experience challenges, and at times direct discrimination, accessing life-saving treatment such as intensive care unit admission and ventilator support. In addition, research has shown that people with disabilities are at higher risk of contracting the virus because of factors that include the need for interpersonal caregivers and living in residential facilities. We explore some of the challenges that people with disabilities residing in South Africa currently experience in relation to accessing healthcare facilities.


Subject(s)
COVID-19/therapy , Disabled Persons/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Poverty , Rural Population/statistics & numerical data , Socioeconomic Factors , South Africa
12.
JMIR Public Health Surveill ; 7(7): e29865, 2021 07 20.
Article in English | MEDLINE | ID: covidwho-1334882

ABSTRACT

BACKGROUND: COVID-19 has disrupted lives and livelihoods and caused widespread panic worldwide. Emerging reports suggest that people living in rural areas in some countries are more susceptible to COVID-19. However, there is a lack of quantitative evidence that can shed light on whether residents of rural areas are more concerned about COVID-19 than residents of urban areas. OBJECTIVE: This infodemiology study investigated attitudes toward COVID-19 in different Japanese prefectures by aggregating and analyzing Yahoo! JAPAN search queries. METHODS: We measured COVID-19 concerns in each Japanese prefecture by aggregating search counts of COVID-19-related queries of Yahoo! JAPAN users and data related to COVID-19 cases. We then defined two indices-the localized concern index (LCI) and localized concern index by patient percentage (LCIPP)-to quantitatively represent the degree of concern. To investigate the impact of emergency declarations on people's concerns, we divided our study period into three phases according to the timing of the state of emergency in Japan: before, during, and after. In addition, we evaluated the relationship between the LCI and LCIPP in different prefectures by correlating them with prefecture-level indicators of urbanization. RESULTS: Our results demonstrated that the concerns about COVID-19 in the prefectures changed in accordance with the declaration of the state of emergency. The correlation analyses also indicated that the differentiated types of public concern measured by the LCI and LCIPP reflect the prefectures' level of urbanization to a certain extent (ie, the LCI appears to be more suitable for quantifying COVID-19 concern in urban areas, while the LCIPP seems to be more appropriate for rural areas). CONCLUSIONS: We quantitatively defined Japanese Yahoo users' concerns about COVID-19 by using the search counts of COVID-19-related search queries. Our results also showed that the LCI and LCIPP have external validity.


Subject(s)
Anxiety/epidemiology , Attitude to Health , COVID-19/psychology , Internet/statistics & numerical data , Search Engine/statistics & numerical data , Adult , Aged , COVID-19/epidemiology , Female , Humans , Japan/epidemiology , Male , Middle Aged , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data
13.
PLoS One ; 16(7): e0251708, 2021.
Article in English | MEDLINE | ID: covidwho-1311280

ABSTRACT

BACKGROUND: COVID-19 is an emerging infectious disease which is a major public health problem worldwide. Given the serious threats imposed by COVID-19 and the absence of vaccines until August 2020, preventive measures play an essential role in reducing infection rates and controlling its spread. This shows the necessity of public adherence for preventive and control measures, which is affected by their knowledge, attitudes, and practices. OBJECTIVE: This study aimed to determine knowledge, attitude, and practice (KAP) towards COVID-19 and associated factors among outpatient service visitors, Debre Markos compressive specialized hospital, north-west,Ethiopia. METHOD: Institutional-based cross-sectional study design with a systematic random sampling technique was conducted from July to August 2020. Among a total of 404 participants, 398 were recruited. Data were collected using a structured questionnaire. The data was edited, coded, and entered into Epi data version 4.6 and exported to SPSS-25 for analysis. Bivariable and multivariable logistic regression models were employed to identify factors associated with KAP. A p-value of <0.05 was considered statistically significant. RESULT: The prevalence of poor knowledge, attitude and practice among the outpatient service visitors were 27.1%, 30.7% and 44%, respectively. The mean age of the participants was 33.4 ±10.9 years. Variables like; educational status, ''can't read and write" [AOR = 3.76, 95% CI (1.36-10.42), P = 0.01], read and write [AOR = 5.90, 95% CI (2.39-14.98), P = 0.01], rural residence [AOR = 3.04, 95% CI (1.43-6.46), P = 0.01] and having no television [AOR = 0.8, 95% CI (0.79-0.89), P = 0.03] were significantly associated with poor knowledge. While, educational status of "can't read and write", [AOR = 6.71, 95% CI (2.78-16.16), P = 0.01] and rural residence [AOR = 2.03, 95% CI (1.14-3.61), P = 0.02] were significantly associated with poor attitude. Additionally, poor knowledge, [AOR = 22.73, 95% CI (10.5-49.21), P = 0.01], rural residence [AOR = 2.08, 95% CI (1.08-4.88), P = 0.04] and having no television [AOR = 2.24, 95% CI (1.05-4.79), P = 0.01] were significantly associated with poor practice. CONCLUSION: In this study, knowledge, attitude, and practice among outpatient service visitors was poor which needs targeted health education and interventions from the health professional to enhance their knowledge, attitude, and practice towards COVID-19. In parallel with this, special attention should be given for the rural community and for those with an educational status of can't read and write.


Subject(s)
COVID-19/psychology , Health Knowledge, Attitudes, Practice , Outpatients/psychology , Adolescent , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Educational Status , Ethiopia , Female , Humans , Income , Male , Mass Screening/psychology , Middle Aged , Quarantine/psychology , Rural Population/statistics & numerical data
14.
Rural Remote Health ; 21(3): 6464, 2021 07.
Article in English | MEDLINE | ID: covidwho-1308598

ABSTRACT

INTRODUCTION: Many rural hospitals and health systems in the USA lack sufficient resources to treat COVID-19. St Lawrence Health (SLH) developed a system for managing inpatient COVID-19 hospital admissions in St Lawrence County, an underserved rural county that is the largest county in New York State. METHODS: SLH used a hub-and-spoke system to route COVID-19 patients to its flagship hospital. It further assembled a small clinical team to manage admitted COVID-19 patients and to stay abreast of a quickly changing body of literature and standard of care. A review of clinical data was completed for patients who were treated by SLH's inpatient COVID-19 treatment team between 20 March and 22 May 2020. RESULTS: Twenty COVID-19 patients were identified. Sixteen patients (80%) met National Institutes of Health criteria for severe or critical disease. One patient died. No patients were transferred to other hospitals. CONCLUSION: During the first 2 months of the pandemic, the authors were able to manage hospitalized COVID-19 patients in their rural community. Development of similar treatment models in other rural areas should be considered.


Subject(s)
COVID-19/drug therapy , Health Services Accessibility/organization & administration , Rural Health/statistics & numerical data , Rural Population/statistics & numerical data , COVID-19/therapy , Female , Hospitals, Rural/organization & administration , Humans , Male , New York
15.
Res Nurs Health ; 44(5): 767-775, 2021 10.
Article in English | MEDLINE | ID: covidwho-1293294

ABSTRACT

The COVID-19 pandemic has had devastating effects on Black and rural populations with a mortality rate among Blacks three times that of Whites and both rural and Black populations experiencing limited access to COVID-19 resources. The primary purpose of this study was to explore the health, financial, and psychological impact of COVID-19 among rural White Appalachian and Black nonrural central Kentucky church congregants. Secondarily we sought to examine the association between sociodemographics and behaviors, attitudes, and beliefs regarding COVID-19 and intent to vaccinate. We used a cross sectional survey design developed with the constructs of the Health Belief and Theory of Planned Behavior models. The majority of the 942 respondents were ≥36 years. A total of 54% were from central Kentucky, while 47.5% were from Appalachia. Among all participants, the pandemic worsened anxiety and depression and delayed access to medical care. There were no associations between sociodemographics and practicing COVID-19 prevention behaviors. Appalachian region was associated with financial burden and delay in medical care (p = 0.03). Appalachian respondents had lower perceived benefit and attitude for COVID-19 prevention behaviors (p = 0.004 and <0.001, respectively). Among all respondents, the perceived risk of contracting COVID was high (54%), yet 33.2% indicated unlikeliness to receive the COVID-19 vaccine if offered. The COVID-19 pandemic had a differential impact on White rural and Black nonrural populations. Nurses and public health officials should assess knowledge and explore patient's attitudes regarding COVID-19 prevention behaviors, as well as advocate for public health resources to reduce the differential impact of COVID-19 on these at-risk populations.


Subject(s)
COVID-19/prevention & control , Protestantism/psychology , Rural Population/statistics & numerical data , Adult , Aged , /psychology , COVID-19/ethnology , COVID-19/psychology , Cross-Sectional Studies , Female , Humans , Kentucky , Male , Middle Aged , Rural Population/trends , Surveys and Questionnaires
16.
Can J Public Health ; 112(4): 595-598, 2021 08.
Article in English | MEDLINE | ID: covidwho-1289327

ABSTRACT

Exclusive breastfeeding for the first 6 months of life has become the global standard of infant feeding for its extensive benefits to maternal and infant health. Public health programs, such as the Baby-Friendly Initiative, have helped increase the national breastfeeding initiation rate to 90%. However, initiation rates in Newfoundland and Labrador (NL) continue to rank the lowest in the country at 70%, with a 6-month exclusivity rate of 16%. This commentary will discuss the influence of geographical location, societal norms, and accessibility to health care services on breastfeeding in rural and remote NL communities. While the SARS-CoV-2 virus itself does not impact the mother's ability to breastfeed, the indirect impacts of COVID-19 on health care services, social isolation, and economic burden challenge breastfeeding initiation and continuation. Priority solutions will draw on capacity building by emphasizing relationships within the community to deliver innovative and appropriate support programs. Continued education with health practitioners and further research into breastfeeding barriers in rural communities is critical moving forward.


Subject(s)
Breast Feeding/statistics & numerical data , COVID-19/epidemiology , Mothers/psychology , Rural Health Services/organization & administration , Rural Population/statistics & numerical data , Female , Humans , Infant , Infant, Newborn , Mothers/statistics & numerical data , Newfoundland and Labrador/epidemiology
17.
PLoS One ; 16(6): e0253466, 2021.
Article in English | MEDLINE | ID: covidwho-1278199

ABSTRACT

OBJECTIVE: Reports of disparities in COVID-19 mortality rates are emerging in the public health literature as the pandemic continues to unfold. Alcohol misuse varies across the US and is related to poorer health and comorbidities that likely affect the severity of COVID-19 infection. High levels of pre-pandemic alcohol misuse in some counties may have set the stage for worse COVID-19 outcomes. Furthermore, this relationship may depend on how rural a county is, as access to healthcare in rural communities has lagged behind more urban areas. The objective of this study was to test for associations between county-level COVID-19 mortality, pre-pandemic county-level excessive drinking, and county rurality. METHOD: We used national COVID-19 data from the New York Times to calculate county-level case fatality rates (n = 3,039 counties and county equivalents; October 1 -December 31, 2020) and other external county-level data sources for indicators of rurality and health. We used beta regression to model case fatality rates, adjusted for several county-level population characteristics. We included a multilevel component to our model and defined state as a random intercept. Our focal predictor was a single variable representing nine possible combinations of low/mid/high alcohol misuse and low/mid/high rurality. RESULTS: The median county-level COVID-19 case fatality rate was 1.57%. Compared to counties with low alcohol misuse and low rurality (referent), counties with high levels of alcohol and mid (ß = -0.17, p = 0.008) or high levels of rurality (ß = -0.24, p<0.001) demonstrated significantly lower case fatality rates. CONCLUSIONS: Our findings highlight the intersecting roles of county-level alcohol consumption, rurality, and COVID-19 mortality.


Subject(s)
Alcoholism/epidemiology , COVID-19/epidemiology , Rural Population/statistics & numerical data , SARS-CoV-2/isolation & purification , Urban Population/statistics & numerical data , Alcoholism/physiopathology , COVID-19/mortality , COVID-19/virology , Comorbidity , Geography , Health Status Disparities , Humans , Models, Theoretical , Multivariate Analysis , Pandemics/prevention & control , Risk Factors , SARS-CoV-2/physiology , Severity of Illness Index , Socioeconomic Factors , Survival Rate , United States/epidemiology
18.
PLoS One ; 16(6): e0253446, 2021.
Article in English | MEDLINE | ID: covidwho-1278197

ABSTRACT

BACKGROUND: COVID-19 is a novel respiratory disease associated with severe morbidity and high mortality in the elderly population and people with comorbidities. Studies have suggested that pregnant women are more susceptible to COVID-19 compared to non-pregnant women. However, it's unclear whether pregnant women in Ghana are knowledgeable about COVID-19 and practice preventive measures against it. This study sought to assess the knowledge and preventive practices towards COVID-19 among pregnant women seeking antenatal services in Northern Ghana. METHODS: A cross-sectional study was conducted using a structured questionnaire in the Nabdam district in Ghana. A total of 527 pregnant women were randomly sampled from health facilities offering antenatal care services in the district. Multivariable logistic regression analysis was used to assess the association between the predictors and outcome variables. RESULTS: The prevalence of adequate knowledge and good COVID-19 preventive practices were 85.6%, (95% CI: 82.57, 88.59) and 46.6%, (95% CI: 42.41, 50.95) respectively. Having at least a primary education, residing in an urban area, and receiving COVID-19 education at a health facility were positively associated with adequate knowledge on COVID-19. Factors positively associated with good COVID-19 preventive practices were older age, having at least a primary education, pregnant women with a chronic disease, and living in an urban area. Multiparity was negatively associated with good COVID-19 preventive practices. CONCLUSION: Although majority of women had adequate knowledge of COVID-19, less than half of them were engaged in good COVID-19 preventive practices. Education of pregnant women on COVID-19 preventive practices should be intensified at health facilities while improving upon the water, sanitation and hygiene need particularly in rural communities.


Subject(s)
COVID-19/prevention & control , Health Knowledge, Attitudes, Practice , Pregnant Women , Prenatal Care/statistics & numerical data , Preventive Medicine/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , COVID-19/epidemiology , COVID-19/virology , Cross-Sectional Studies , Educational Status , Female , Ghana/epidemiology , Humans , Logistic Models , Multivariate Analysis , Pandemics/prevention & control , Pregnancy , Prenatal Care/methods , Preventive Medicine/methods , Rural Population/statistics & numerical data , SARS-CoV-2/physiology , Surveys and Questionnaires , Young Adult
19.
JAMA Netw Open ; 4(6): e2113787, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1274644

ABSTRACT

Importance: COVID-19 lockdowns may affect economic and health outcomes, but evidence from low- and middle-income countries remains limited. Objective: To assess the economic security, food security, health, and sexual behavior of women at high risk of HIV infection in rural Kenya during the COVID-19 pandemic. Design, Setting, and Participants: This survey study of women enrolled in a randomized trial in a rural county in Kenya combined results from phone interviews, conducted while social distancing measures were in effect between May 13 and June 29, 2020, with longitudinal, in-person surveys administered between September 1, 2019, and March 25, 2020. Enrolled participants were HIV-negative and had 2 or more sexual partners within the past month. Surveys collected information on economic conditions, food security, health status, and sexual behavior. Subgroup analyses compared outcomes by reliance on transactional sex for income and by educational attainment. Data were analyzed between May 2020 and April 2021. Main Outcomes and Measures: Self-reported income, employment hours, numbers of sexual partners and transactional sex partners, food security, and COVID-19 prevention behaviors. Results: A total of 1725 women participated, with a mean (SD) age of 29.3 (6.8) years and 1170 (68.0%) reporting sex work as an income source before the COVID-19 pandemic. During the pandemic, participants reported experiencing a 52% decline in mean (SD) weekly income, from $11.25 (13.46) to $5.38 (12.51) (difference, -$5.86; 95% CI, -$6.91 to -$4.82; P < .001). In all, 1385 participants (80.3%) reported difficulty obtaining food in the past month, and 1500 (87.0%) worried about having enough to eat at least once. Reported numbers of sexual partners declined from a mean (SD) total of 1.8 (1.2) partners before COVID-19 to 1.1 (1.0) during (difference, -0.75 partners; 95% CI, -0.84 to -0.67 partners; P < .001), and transactional sex partners declined from 1.0 (1.1) to 0.5 (0.8) (difference, -0.57 partners; 95% CI, -0.64 to -0.50 partners; P < .001). In subgroup analyses, women reliant on transactional sex for income were 18.3% (95% CI, 11.4% to 25.2%) more likely to report being sometimes or often worried that their household would have enough food than women not reliant on transactional sex (P < .001), and their reported decline in employment was 4.6 hours (95% CI, -7.9 to -1.2 hours) greater than women not reliant on transactional sex (P = .008). Conclusions and Relevance: In this survey study, COVID-19 was associated with large reductions in economic security among women at high risk of HIV infection in Kenya. However, shifts in sexual behavior may have temporarily decreased their risk of HIV infection.


Subject(s)
COVID-19 , HIV Infections/etiology , Income/statistics & numerical data , Physical Distancing , Sexual Behavior/statistics & numerical data , Adult , Female , Humans , Kenya , Longitudinal Studies , Poverty/statistics & numerical data , Randomized Controlled Trials as Topic , Risk-Taking , Rural Population/statistics & numerical data , SARS-CoV-2 , Sex Work/statistics & numerical data , Sexual Partners , Surveys and Questionnaires , Young Adult
20.
J Rural Health ; 36(3): 446-456, 2020 06.
Article in English | MEDLINE | ID: covidwho-1276750

ABSTRACT

PURPOSE: This study creates a COVID-19 susceptibility scale at the county level, describes its components, and then assesses the health and socioeconomic resiliency of susceptible places across the rural-urban continuum. METHODS: Factor analysis grouped 11 indicators into 7 distinct susceptibility factors for 3,079 counties in the conterminous United States. Unconditional mean differences are assessed using a multivariate general linear model. Data from 2018 are primarily taken from the US Census Bureau and CDC. RESULTS: About 33% of rural counties are highly susceptible to COVID-19, driven by older and health-compromised populations, and care facilities for the elderly. Major vulnerabilities in rural counties include fewer physicians, lack of mental health services, higher disability, and more uninsured. Poor Internet access limits telemedicine. Lack of social capital and social services may hinder local pandemic recovery. Meat processing facilities drive risk in micropolitan counties. Although metropolitan counties are less susceptible due to healthier and younger populations, about 6% are at risk due to community spread from dense populations. Metropolitan vulnerabilities include minorities at higher health and diabetes risk, language barriers, being a transportation hub that helps spread infection, and acute housing distress. CONCLUSIONS: There is an immediate need to know specific types of susceptibilities and vulnerabilities ahead of time to allow local and state health officials to plan and allocate resources accordingly. In rural areas it is essential to shelter-in-place vulnerable populations, whereas in large metropolitan areas general closure orders are needed to stop community spread. Pandemic response plans should address vulnerabilities.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Age Factors , Betacoronavirus , COVID-19 , Health Services Accessibility/statistics & numerical data , Health Status , Humans , Mental Health , Pandemics , SARS-CoV-2 , Social Capital , Social Work/statistics & numerical data , Socioeconomic Factors , United States/epidemiology
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