ABSTRACT
Vaccine hesitancy is a global threat to public health. Hesitant individuals pose a major concern, as they can be viewed as a source of infection, which may lead to another outbreak. Effective strategies are needed to increase uptake, decrease hesitancy, and achieve herd immunity. This study aims to identify the impact of implemented strategies on COVID-19 vaccine hesitancy and uptake among final-year pharmacy students, and their acceptance and attitudes towards mandatory COVID-19 vaccination. An anonymous, internet-based cross-sectional study was developed using Google Forms and administered to final-year pharmacy students (254) at all pharmacy colleges in Wad Medani city, Sudan between August and September 2022. Overall, 30.7 % of students were hesitant to get the COVID-19 vaccine. The majority of students, 69.3 %, were already vaccinated and 60.9 % of them were initially hesitant about getting the vaccine but eventually did so. Receiving the COVID-19 vaccine was significantly associated with the institution students attended (p < 0.001). Institutions that had implemented encouraging vaccination strategies had a higher percentage of vaccinated students: 84.2 % and 77.1 %, compared to the institution that did not adopt any vaccination strategies 28.3 %. Availability of COVID-19 vaccines to students (OR 1.67 CI (0.70-3.96)), and encouraging COVID-19 vaccination in a way close to mandatory (OR 4.29, CI (1.85-9.96)) had the highest odds in increasing the vaccination uptake. While, not implementing any vaccination strategy (OR 0.24, CI (0.07-0.85) was less likely to increase vaccination uptake. Also, it was found that 72.5 % of students would accept mandatory vaccination for COVID-19. This study provides policymakers with evidence-based strategies that could increase the uptake and decrease hesitancy toward COVID-19 vaccines among a group of university students. Policymakers should encourage all universities to provide COVID-19 vaccines to their students, either through clinics or vaccination campaigns, and consider mandating the COVID-19 vaccine.
ABSTRACT
Background: Warfarin is well known as a narrow therapeutic index that has prodigious variability in response which challenges dosing adjustment for the maintenance of therapeutic international normalized ratio. However, an appreciated population not on new oral anticoagulants may still need to be stabilized with warfarin dosing. Objective: The current study's main objective was to validate and compare two models of warfarin clinical algorithm models namely the Gage and the International Warfarin Pharmacogenetics Consortium (IWPC) with warfarin 5 mg fixed standard dosing strategy in a sample of Sudanese subjects. Method: We have conducted a cross-sectional study recruited from the out-patient clinic at a tertiary specialized heart center. We included subjects with unchanged warfarin dose (stabilized), and with therapeutic international normalized ratio. The predicted doses of warfarin in the two models were calculated by three different methods (accuracy, clinical practicality, and the clinical safety of the clinical algorithms). Main outcome measure: The primary outcomes were the measurements of the clinical (accuracy, practicality, and safety) in each of the two clinical algorithms models compared to warfarin 5 mg fixed standard dose strategy. Results: We have enrolled 71 Sudanese subjects with mean age (51.7 ± 14 years), of which (49, 69.0%) were females. There was no significant difference between the warfarin 5 mg fixed standard dose strategy and the predicted doses of the two clinical algorithm models (MAE 1.44, 1.45, and 1.49 mg/day [P =0.4]) respectively. In the clinical practicality, all of the three models had a high percent of subjects (95.0%, 51.9%, and 66.7%) in the ideal dose range in middle dose group (3-7 mg/ day) for warfarin 5 mg fixed standard dosing strategy, Gage, and IWPC clinical algorithm models respectively. However, a small percent of subjects was exhibited in the warfarin low dose group ≤ 3 mg/day (0.0%, 15.0%, and 10.0%) and warfarin high dose group ≥ 7 mg/day (0.0%, 33.3%, and 33.3%) for warfarin 5 mg fixed standard dosing strategy, Gage, and IWPC clinical algorithms respectively. In terms of clinical safety, the percent of subjects with severely over-prediction were 28.2%, 22.5%, and 22.5% for warfarin 5 mg fixed standard dosing, Gage, and IWPC, respectively. While the percent of severely under-prediction was 12.7%, 7.0%, and 5.6% for the warfarin 5 mg fixed standard dosing, Gage, and IWPC, respectively. Conclusion: The Gage and IWPC clinical algorithm models were accurate, more clinically practical, and clinically safe than warfarin 5 mg standard dosing in the study population. The cardiologist can use either models (Gage and IWPC) to stratify subjects for accurate, practical, and clinically safe warfarin dosing..
