COVID-19 in the Federation of Bosnia and Herzegovina: Strengthening the public health surveillance using a web-based system to inform public health response, March 2020 - March 2022.

In response to the significant public health threat caused by coronavirus disease (COVID-19), real-time surveillance, containment, and mitigation measures were implemented in the Federation of Bosnia and Herzegovina (FBiH). Our objective was to describe the surveillance methodology, response measures, and epidemiology of COVID-19 cases in FBiH from March 2020 to March 2022. The surveillance system implemented across FBiH enabled health authorities and the population to monitor the development of the epidemiological situation, the daily number of reported cases, as well as basic epidemiological characteristics and geographic distribution of cases. As of 31 March 2022, 249,495 cases of COVID-19, and a total of 8,845 deaths were recorded in FBiH. Upkeeping of real-time surveillance, maintaining non-pharmaceutical interventions, and speeding up the vaccination roll-out were paramount for controlling COVID-19 in FBiH.

Satisfaction with Health Care Services in the Adult Population of the Federation of Bosnia and Herzegovina during the COVID-19 Pandemic.

Background and Objectives: Patient satisfaction with health care can influence health care-seeking behavior in relation to both minor or major health problems or influence communication and compliance with medical advice, which is especially important in emergencies such as the COVID-19 pandemic. Thus, it is important to continually monitor patient satisfaction with provided care and their dynamics. The aim of this study was to assess patient satisfaction with health care during the COVID-19 pandemic in the adult population of the Federation of Bosnia and Herzegovina (FB&H) and compare it with levels of satisfaction in the same population before the COVID-19 pandemic. Materials and Methods: A representative, population-based survey was implemented in the adult population of the FB&H using the EUROPEP instrument, which measures satisfaction with health care using 23 items. The sample included 740 respondents who were 18 years or older residing in the FB&H and was implemented in December 2020. All data were collected using a system of online panels. The survey questions targeted the nine months from the beginning of the pandemic to the time of data collection, i.e., the period of March to December 2020. Results: The mean composite satisfaction score across all 23 items of the EUROPEP tool was 3.2 points in all age groups; the ceiling effect was 22% for the youngest respondents (18-34 years old), 23% for 35-54 years old, and 26% for the oldest group (55+), showing increasing satisfaction by age. The overall composite score for both females and males was 3.2. The ceiling effect was higher in those with chronic disease (29% vs. 23% in those without chronic disease). The composite mean score for respondents residing in rural vs. urban areas was 3.2 with a ceiling effect of 22% in rural and 24% in urban residents. When comparing mean composite scores surveyed at various points in time in the FB&H, it was found that the score increased from 3.3 to 3.5 between 2011 and 2017 and dropped again to 3.3 in this study. Despite these observations in the overall trends of satisfaction scores, we note that no statistically significant differences were observed between most of the single-item scores in the stratified analysis, pointing to the relative uniformity of satisfaction among the analyzed population subgroups. Conclusions: The rate of satisfaction with health care services in the FB&H was lower during the COVID-19 pandemic compared to 2011 and 2017. Furthermore, while an increasing trend in satisfaction with health care was observed in the FB&H during the years prior to 2020, the COVID-19 pandemic may have contributed to the reversal of this trend. It is important to further monitor the dynamics of patient satisfaction with health care, which could serve as a basis for planning, delivering, and maintaining quality services during the COVID-19 pandemic and other emergencies.

Population Perspectives on Impact of the COVID-19 Pandemic on Essential Health Services-Behavioral Insights from the Federation of Bosnia and Herzegovina.

The aim of this study was to analyze the impact of the COVID-19 pandemic on patterns of use of essential health services (EHS), health-seeking behaviors, and population health and wellbeing in the Federation of Bosnia and Herzegovina (FBiH) from the perspective of its adult population. A population-based survey was implemented in the FBiH in December 2020 on a sample of 1068 adults. Overall, 64% of respondents received care, significantly more being women (67% vs. 61%, p = 0.046), those with a chronic disease (CD) (75% vs. 65%, p < 0.001), and of an older age (58% in 18−34 vs. 67% in older, p = 0.031). These groups also postponed care more often (39% in 55+ vs. 31% in 18−34 years old, p = 0.01; 55% with CD vs. 31% without, p < 0.001; and 43% in females vs. 32% males, p < 0.001). Main reasons for postponing care were lack of available appointments and fear of infection. The presence of a CD was the strongest predictor of need, access, and disruptions of health care. Respondents reported increased expenses for medicines (40%) and health services (30%). The findings of the survey add user insights into EHS disruptions to existing health statistics and other data and may be used to inform strategies for mitigating the impact of COVID-19 on the disruption of health care services, strengthening health system preparedness and building resilience for future emergencies.

COVID-19 Risk Perception, Trust in Institutions and Negative Affect Drive Positive COVID-19 Vaccine Intentions.

Objectives: To investigate country-specific drivers and barriers of positive COVID-19 vaccine intentions in the Federation of Bosnia and Herzegovina (FBiH), one of the two entities comprising Bosnia and Herzegovina. Methods: A cross-sectional study design was used, using an online behavioural insights survey tool adapted to the context of FBiH. Three survey waves, each including approximately 1,000 adults, were conducted in July, September and December 2020. Fixed-effects regression analysis was used to explore the drivers, barriers and attitudes towards accepting a future COVID-19 vaccine. Results: COVID-19 risk perception, trust in health institutions and negative affect were positive predictors of positive COVID-19 vaccine intentions, as were living in urban areas and having a college education (versus having primary or secondary education). Conversely, being female, feeling that the pandemic was overhyped by the media and the country of vaccine production were negative predictors. Conclusion: This study provided snapshots on the state of attitudes regarding a future COVID-19 vaccine acceptance and hesitancy in 2020. These findings provided useful insights into the efforts to introduce and roll out the COVID-19 vaccines in FBiH. Further efforts should focus on better understanding the demographic, cultural and behavioural contexts of COVID-related vaccination perceptions in FBiH.

Household transmission of SARS-CoV-2: a prospective observational study in Bosnia and Herzegovina, August-December 2020.

BACKGROUND: The secondary attack rate (SAR) of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was estimated, and the risk factors for infection among members of households with a coronavirus disease 2019 (COVID-19) index case were identified to inform preventive measures. METHODS: Between 3 August and 19 December 2020, a household transmission study was implemented based on a standardized World Health Organization protocol. Laboratory-confirmed cases of SARS-CoV-2 infection were recruited through the federal COVID-19 database. Trained contact tracers interviewed index cases and household members to collect information on demographic, clinical and behavioural factors. Contacts were followed up for 28 days to identify secondary infections. SAR was estimated and odds ratios (OR) were calculated for risk factors for transmission. RESULTS: In total, 383 households and 793 contacts were included in this study. The overall SAR was 17% [95% confidence interval (CI) 14-21]. Contacts had higher risk for infection if the primary case had both cough and runny nose (OR 4.31, 95% CI 1.60-11.63), if the contact was aged 18-49 years (OR 4.67, 95% CI 1.83-11.93), if the contact kissed the primary case (OR 3.16, 95% CI 1.19-8.43), or if the contact shared a meal with the primary case (OR 3.10, 95% CI 1.17-8.27). CONCLUSIONS: These results add to the global literature by providing evidence from a middle-income setting. Standard preventive measures in households with positive cases remain critical to reduce transmission.

An Overview of Human Resources and Capacity in Health Care Institutions in the Federation of Bosnia and Herzegovina in the Context of Responding to the COVID 19 Pandemic.

BACKGROUND: The organization of health care system on Cantonal level with the coordination from Federal level represents a real situation with the possibility of decentralization of health care system according to the experiences of developed countries. OBJECTIVE: To make an overview of the situation at the primary and hospital health care level with the aim of assessing the existing human resources and capacity of health care institutions in FB&H, with which we entered in COVID-19 pandemic. METHODS: This retrospective study presents the efficiency of health care in FB&H measured by number of medical doctors, and other medical staff during the time period of five years. Data of the Institute for Public Health FB&H were used. The Institute for Public Health FB&H is authorised by the law to conduct and implement statistical research in the field of health care in line with relevant laws and by-laws. The Institute is obliged to report on organisational structure, human resources and medical equipment. RESULTS: Presented data include the number of health care employees in medical institutions in FB&H in the period 2015-2019 per 100,000 inhabitants and their numbers in primary health care, family medicine, secondary and tertiary level of health care in 2019. The study also presents the number of doctors of medicine, specialists and medical residents in FB&H, the number of nurses of all profiles and levels of education as well as medical staff and other employees in the public health care system in FB&H in 2019. CONCLUSIONS: The COVID-19 pandemic in FB&H has confirmed the fact that human resources in health care are insufficient, especially in the field of public health and epidemiology. The availability of these health facilities and human resource is not uniform throughout the FB&H, which may affect the capacity of the health system in some parts of the FB&H to meet the needs of providing services during COVID-19 pandemic.

Phylogenetic pattern of SARS-CoV-2 from COVID-19 patients from Bosnia and Herzegovina: lessons learned to optimize future molecular and epidemiological approaches.

This is the first report of molecular and epidemiology findings from Bosnia and Herzegovina related to ongoing severe acute respiratory syndrome coronavirus 2 epidemic. Whole genome sequence of four samples from coronavirus disease 2019 (COVID-19) outbreaks was done in two laboratories in Bosnia and Herzegovina (Veterinary Faculty Sarajevo and Alea Genetic Center). All four BiH sequences cluster mainly with European ones (Italy, Austria, France, Sweden, Cyprus, and England). The constructed phylogenetic tree indicates possible multiple independent introduction events. The data presented contribute to a better understanding of COVID-19 in the current reemergence of the disease.