ABSTRACT
Vaccination is an important strategy in the fight against COVID-19. Although Sudan received vaccines since March 2021, vaccine uptake is very low. This study aimed to determine COVID-19 vaccine uptake and hesitancy in one of the largest Urban settings in Sudan. A survey was done among adults from 15 market places in Wad Medani city. Collected data included; demographic characteristics, vaccination status, type of received vaccine, number of received doses, side effects experienced after vaccination and reasons for refusing or delaying vaccination. In total, 1323 questionnaires were eligible for analysis. Most respondents were male (55.5%), younger than 60 years of age (89.5%) and received some sort of formal education (92.7%). Education level was significantly associated with vaccination uptake (p < 0.001). At the time of the study; 33.2%, 42%, 16.8% and 8% of participants were vaccinated, willing to receive vaccination, rejecting vaccination or haven't decided to receive a COVID-19 vaccine yet respectively. The most common reason for rejection indicated by participants was safety concerns (79.3%). Reasons for hesitance expressed by 64% of participant who said they were willing to take the vaccine were unavailability and difficult access to vaccines. Participants who expressed willingness to receive COVID-19 vaccine (42%) or were undecided (8%) were invited to a vaccination campaign. Of these, 27.9% attended and received their first shot of COVID-19 vaccine. Education level seems to be the main determinant for vaccination hesitancy. Safety concerns seem to play a major role in rejecting and delaying COVID-19 vaccination. Assuring vaccine's safety seems to be the way forward to reduce concerns about vaccination safety. Hesitancy was also shown to be partially related to difficulty in access to vaccines and a large proportion of the population are expected to receive the vaccine by improving availability and access.
ABSTRACT
CONTEXT: Evidence is needed to inform expansion of hospital-based palliative care in low and middle-income countries. OBJECTIVES: This study aimed to measure need for palliative care among adult inpatients at five hospitals in Sudan. Objectives were to 1) measure point prevalence of life-limiting and life-threatening illness (LL/LTI); 2) determine patient insight into diagnosis and prognosis; 3) assess palliative care-related symptoms and concerns. METHODS: In this two-day census, data were extracted from charts on documented LL/LTI for each occupied bed. For patients with LL/LTI, self-report data was collected on symptoms, concerns and understanding of diagnosis and prognosis using Integrated African Palliative Outcome Scale (IAPOS). RESULTS: 1) Prevalence of LL/LTI in general hospitals was 30.9%-70.5%. 2) n = 439 patients gave self-report data (response rate 89.8%). Mean age was 52.3 (SD 17.8), 59% of patients correctly knew their diagnosis, and 36% knew their illness was progressive. Those with a non-cancer diagnosis were significantly less likely to know their prognosis (28.4% vs 40.7% respectively, P = 0.012). 3) Family anxiety was most burdensome (56.7% scoring on the two most severe categories on a 6-point Likert), followed by pain (52.4%), poor mobility (40.5%), patient worry (39.9%), and fatigue (36.9%). Patients unaware of prognosis had higher total IAPOS scores than those aware their prognosis was progressive, 38.9 (SD = 15.6) (t = -3.297, P = 0.001, mean difference = -5.010, 95% CI: -7.997, -2.023). CONCLUSION: Care for those with life-limiting and life-threatening illness places a significant occupancy burden on public hospitals. Communication skills are required to provide patients with insight, and core palliative care skills for acute hospital clinicians are needed to manage the high burden of symptoms and concerns.
