COVID-19 excess deaths in Eastern European countries associated with weaker regulation implementation and lower vaccination coverage

Background: Since winter 2020, excess deaths due to COVID-19 have been higher in Eastern Europe than most of Western Europe, partly because regulatory enforcement was poor. Methods: This paper analysed data from 50 countries in the WHO European Region, in addition to data from USA and Canada. Excess mMortality and vaccination data were retrieved from “Our World In Data” and regulation implementation was assessed using standard methods. Multiple linear regression was used to assess the association between mortality and each covariate. Results: Excess mortality increased by 4.1 per 100 000 (P = 0.038) for every percentage decrease in vaccination rate and with 6/100 000 (p=0.011) for every decreased unit in the regulatory implementation score a country achieved in the Rule of Law Index. Conclusion: Degree of regulation enforcement, likely including public health measure enforcement, may be an important factor in controlling COVID-19’s deleterious health impacts.

COVID-19 excess death rate in Eastern European countries associated with weaker regulation implementation and lower vaccination coverage

AimThe objective of this analysis was to assess the association of excess COVID-19 mortality with regulation enforcement and vaccination rate in selected countries. MethodsThis analysis included 50 countries pertinent to the WHO European Region, in addition to USA and Canada. Excess mortality and vaccination data were retrieved from "Our World In Data" database, while regulation implementation was measured from a well-respected, standardized measure. Outpatient visits were also included in the analysis. Multiple linear regression was used to assess the independent association between excess mortality and each covariate. ResultsExcess mortality increased by 4.1/100 000 for every percent decrease in vaccination rate and with 6/100 000 for every decreased unit in the regulatory implementation score a country achieved in the Rule of Law Index. ConclusionDegree of regulation enforcement, likely including public health measure enforcement, may be an important factor in controlling COVID-19s deleterious health impacts.

Prevalence and sociodemographic correlates of medication intake adherence among primary health-care users in Albania

Background: Evidence about the magnitude and determinants of medication intake adherence among patients and the general population in Southeastern Europe is scant. Aims: To assess the prevalence and sociodemographic correlates of medication intake adherence among adult primary healthcare (PHC) users in Albania. Methods: A cross-sectional study was conducted in 2018–2019 in a representative sample of 1553 adult PHC users (response: 94%) selected probabilistically from 5 major regions of Albania. There were 849 (55%) women and 704 (45%) men, with a mean age 54.6 (16.4) years. A structured interviewer-administered questionnaire inquired about medication intake adherence prescribed by family physicians, and sociodemographic characteristics. Binary logistic regression was used to assess the sociodemographic correlates of medication intake adherence. Results: Three hundred (19.8%) participants did not take the prescribed medication. In multivariable-adjusted logistic model, significant correlates of nonintake of medication included rural residence, low educational level, unemployment and low economic level. Among these 300 participants, 273 (91%) considered the high cost of the drugs as a reason for not taking the medication. Conclusion: We found a high prevalence of nonintake of medication prescribed by family physicians. Decision-makers and policymakers in Albania and elsewhere should consider the provision of essential drugs free of charge or at low cost to low socioeconomic groups and other vulnerable and marginalized population categories, because the costs of noncompliance will eventually be higher.

Rapid increase of SARS-CoV-2 seroprevalence during the 2020 pandemic year in the population of the city of Tirana, Albania

IntroductionWhile the identification of anti SARS-CoV-2 antibodies has been used to measure the hidden circulation of the COVID-19 in communities, there are few publications on the dynamics of SARS-CoV-2 seroprevalence during both waves of 2020. This study provides original data about the change in proportion of individuals showing immune response to COVID-19 between beginning of July and end of December 2020. MethodsThe study was conducted in two rounds, 27 June -3 July, and 21-28 December 2020, using two independently selected samples of individuals 20-70 years old. Study participants were randomly selected from lists of the inhabitants of the catchment communities of four primary health care centers in Tirana City. Serological testing was performed by an ELISA method which determines IgG class antibodies anti S1 protein of SARS-CoV-2 virus. The validity of the method was tested in a sample of blood donors sera of 2018. ResultsThe proportion of individuals classified as seropositive during the first round, in early July was 7.5% (95% CI: 4.3% -10.7%). The proportion rose sharply in the second round, by late December 2020, reaching 48.2% (95% CI: 44.8% -51.7%). The same increasing pattern was observed in all studied categories. No statistical significance was found between men and women and between age categories. The prevalence of seropositive individuals was always significantly higher among those who reported symptoms and those who had done the molecular test. ConclusionThe ratio of total infected cases over confirmed cases was estimated to be higher than 10 to 1 in Albania. The rapid increase in SARS-CoV-2 seroprevalence observed in Tirana City may have been facilitated by a number of factors, including the very low infection exposure during the period March -May 2020, and the consecutive high susceptibility in population. Despite the observed high seroprevalence, one month after the study, COVID-19 incidence continued to increase in Tirana.

The lower COVID-19 related mortality and incidence rates in Eastern European countries are associated with delayed start of community circulation

BackgroundThe purpose of this analysis was to assess the variations in COVID-19 related mortality and incidence rates in relation to the time differences in the commencement of virus circulation and containment measures in different countries of the European Region. MethodsThe data for the current analysis (N=50 countries) were retrieved from the John Hopkins University dataset on the 7th of May 2020, with countries as study units. A piecewise regression analysis was conducted with mortality and cumulative incidence rates introduced as dependent variables and time interval (days from the 22nd of January to the date when 100 first cases were reported) as the main predictor. The country average life expectancy at birth was statistically adjusted for in the regression model. ResultsMortality and incidence were strongly and inversely intercorrelated with days from January 22, respectively -0.83 (p<.0001) and -0.73 (p<.0001). Adjusting for average life expectancy, between days 33 to 50 from the 22th of the January, the average mortality rate decreased by 30.4/million per day (95% CI: 23.2, 37.1, p<0.0001). During interval 51 to 73 days, the change in mortality was no longer statistically significant but still showed a decreasing trend. A similar relationship with time interval was found in incidence. Life expectancy was not associated with mortality rate. ConclusionCountries in Europe which observed the earliest COVID-19 circulation, suffered the worst consequences in terms of health outcomes, specifically mortality. The drastic social isolation measures, undertaken especially in Eastern European countries, where community circulation started after March 11th, may have been timely. This may explain their significantly lower COVID-related mortality compared with the Western European countries.

Behavioral risk factors and prevalence of HIV and other STIs among female sex workers in Tirana, Albania.

The paper presents the results of the research and a comparative analysis of findings on key indicators for the study population. The study instrument was a standardized behavior study questionnaire provided in the Family Health International published manual (Family Health International, 2000). The target group was female sex workers working in Tirana. The prevalence of biological infections was low. HIV was detected in one case. Syphilis and Hepatitis B rates resulted to be respectively 6.5% and 7.6%. The median age of the study participants is 28 years. Almost 38% of the participants were illiterate, and more than half belong to the Roma community. Almost 50% of the respondents had received money in exchange of sex for the first time 18 years earlier. Almost 65% of respondents reported two or more different sex partners in the last seven days, while almost 30% referred five or more. Condom use at last sex with a paying client was reported by almost 68%. Consistent condom use with paying clients in the last month was reported by almost 35% of the respondents.