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BackgroundTransmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen spread and the effectiveness of control efforts. Most analyses of contact patterns to date have focussed on high-income settings. MethodsHere, we conduct a systematic review and individual-participant meta-analysis of surveys carried out in low- and middle-income countries and compare patterns of contact in these settings to surveys previously carried out in high-income countries. Using individual-level data from 28,503 participants and 413,069 contacts across 27 surveys we explored how contact characteristics (number, location, duration and whether physical) vary across income settings. ResultsContact rates declined with age in high- and upper-middle-income settings, but not in low-income settings, where adults aged 65+ made similar numbers of contacts as younger individuals and mixed with all age-groups. Across all settings, increasing household size was a key determinant of contact frequency and characteristics, but low-income settings were characterised by the largest, most intergenerational households. A higher proportion of contacts were made at home in low-income settings, and work/school contacts were more frequent in high-income strata. We also observed contrasting effects of gender across income-strata on the frequency, duration and type of contacts individuals made. ConclusionsThese differences in contact patterns between settings have material consequences for both spread of respiratory pathogens, as well as the effectiveness of different non-pharmaceutical interventions. FundingThis work is primarily being funded by joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1).
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This qualitative study explores the impact of non-pharmaceutical interventions (NPIs) on lived experiences during the first wave of the COVID-19 pandemic on peoples lives in Thailand, Malaysia, Italy and the United Kingdom. A total of 86 interviews were conducted with members of the public, including healthcare workers. Participants across countries held strong views on NPIs, with many feeling measures lacked clarity. Most participants reported primarily negative impacts of NPIs on their lives, including through separation, isolation and grief over missed milestones; work-related challenges and income loss; and poor mental health and wellbeing. Nonetheless, many also experienced inadvertent positive consequences, including more time at home to focus on what they most valued in life; a greater sense of connectedness; and benefits to working life. Commonly employed coping strategies focused on financial coping; psycho-emotional coping; social coping and connectedness; reducing and mitigating risks; and limiting exposure to the news. Importantly, the extent to which participants lived experiences were positive or negative, and their ability to cope was underpinned by individual, social and economic factors. In order to mitigate negative and unequal impacts of NPIs, COVID-19 policies will benefit from paying closer attention to the social, cultural and psychological--not just biological--vulnerabilities to, and consequences of public health measures.
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In the absence of a vaccine and widely available treatments for COVID-19, governments have relied primarily on non-pharmaceutical interventions to curb the pandemic. To aid understanding of the impact of these public health measures on different social groups we conducted a mixed-methods study in five countries ( SEBCOV - Social, ethical and behavioural aspects of COVID-19). Here we report the results of the SEBCOV anonymous online survey of adults. Overall, 5,058 respondents from Thailand, Malaysia, the United Kingdom, Italy and Slovenia completed the self-administered survey between May and June 2020. Post-stratification weighting was applied, and associations between categorical variables assessed. Among the five countries, Thai respondents appeared to have been most, and Slovenian respondents least, affected economically. Overall, lower education levels, larger households, having children under 18 in the household, being 65 years or older and having flexible/no income were associated with worse economic impact. Regarding social impact, respondents expressed most concern about their social life, physical health, and mental health and wellbeing. There were large differences between countries in terms of voluntary behavioural change, and in compliance and agreement with COVID-19 restrictions. Overall, self-reported compliance was higher among respondents reporting a high understanding of COVID-19. UK respondents felt able to cope the longest and Thai respondents the shortest with only going out for essential needs or work, with 60% and 26% respectively able to cope with 29 days or longer. Many respondents reported seeing news that seemed fake to them, the proportion varying between countries, and with education level and self-reported levels of understanding of COVID-19. Our data showed that COVID-19 public health measures have uneven economic and social impacts on people from different countries and social groups. Understanding the factors associated with these impacts can help to inform future public health interventions and mitigate their negative consequences on peoples lives. SummaryO_ST_ABSWhat is already known?C_ST_ABSO_LICOVID-19 public health measures and lockdowns most negatively affect those who are socio-economically disadvantaged. C_LIO_LIMisinformation about COVID-19 is widespread. C_LI What are the new findings?O_LIIn the countries in which we conducted our survey, lower education levels, larger households, having children under 18 in the household, being 65 years or older and having flexible/no income were associated with worse economic impact. C_LIO_LIThere were large differences between countries in terms of voluntary change of behaviour, as well as compliance and agreement with COVID-19 related public health measures. C_LIO_LIYounger age and lower education levels appear to be associated with lower self-perceived levels of understanding of COVID-19. C_LIO_LIA significant proportion of the population received conflicting information and news that seemed fake to them, in particular about coronavirus being an engineered modified virus. C_LI What do the new findings imply?O_LIOur findings imply that there are significant differences in how people from different social groups and different countries experienced COVID-19 and related public health measures, and any support initiatives should take this into account. C_LIO_LIOur findings confirm that communication around COVID-19 could be improved, and help identify specific areas to target (e.g. origin of virus) and specific groups of people who may benefit most from improved communication (e.g. younger people, those with lower levels education). C_LI
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Objectives@#This study assessed the technical feasibility and aimed to determine the factors influencing intention to use Electronic Medical Records (EMRs) at Marie Stopes International, Myanmar (MSI-M). @*Methods@#A cross-sectional survey was conducted among 112 participants who were working at the clinics and head office of MSI-M. Demographic information, type of office, technical feasibility, information communication technology knowledge, computer usage, and user acceptance towards the proposed system were obtained from the participants. @*Results@#The results indicated low health information technology usage and network availability at MSI-M clinics. Positive perception of EMRs was found among the staff members of MSI-M, which was reflected by positive responses regarding perceived usefulness (average score of 4.15), perceived ease of use (average score of 4.03), and intention to use (average score of 4.10) on a 5-point Likert scale. Statistically, staff from the head office expressed less desire to implement an EMR system (odds ratio = 0.07; 95% confidence interval, 0.01–0.97), especially when they do not perceive the usefulness of the system (odds ratio = 5.05; 95% confidence interval, 2.39–10.69). @*Conclusions@#Since health information technology usage and network availability were low in MSI-M, it is important to strengthen the information and communication technology infrastructure and introduce a policy for capacity building at MSI-M. Adequate training and strong leadership support are recommended for the successful initial implementation and sustainability of an EMR system at MSI-M.
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OBJECTIVES: To overcome challenges in the implementation of electronic dental record systems in a low-resource setting, it is crucial to know the level of users’ satisfaction with the existing system of paper-based dental records and their perceptions of electronic dental records. METHODS: A cross-sectional paper-based questionnaire survey was conducted among Myanmar dental professionals who worked in one of two teaching hospitals or in private dental clinics. Descriptive data were analyzed and regression analysis was carried out to identify factors influencing perceptions of electronic dental records. RESULTS: Most dental professionals (>60%) were satisfied with just three out of six aspects of paper-based dental records (familiarity, flexibility, and portability). In addition, generalized positive perceptions were found among decision makers towards electronic dental records, and 86% of dentists indicated that they were willing to use them. Financial concerns were identified as the most important barrier to the implementation of electronic dental records among dentists who were not willing to use the proposed system. CONCLUSIONS: The first step towards implementing electronic dental records in Myanmar should be improvement of the content and structure of paper-based dental records, especially in private dental clinics. Utilization of appropriate open-source electronic dental record software in private dental clinics is recommended to address perceived issues around financial barriers. For the long term, we recommend providing further education and training in health informatics to healthcare professionals to facilitate the efficient use of electronic dental record software in Myanmar in the future.
Subject(s)
Humans , Delivery of Health Care , Dental Clinics , Dental Records , Dentists , Education , Hospitals, Teaching , Informatics , Myanmar , PliabilityABSTRACT
Background: Developing a quantitative understanding of pandemic influenza dynamics in SouthEast Asia is important for informing future pandemic planning. Hence, transmission dynamics ofinfluenza A/H1N1 were determined across space and time in Thailand.Methods: Dates of symptom onset were obtained for all daily laboratory-confirmed cases of influenzaA/H1N1pdm in Thailand from 3 May 2009 to 26 December 2010 for four different geographicregions (Central, North, North-East, and South). These data were analysed using a probabilisticepidemic reconstruction, and estimates of the effective reproduction number, R(t), were derivedby region and over time.Results: Estimated R(t) values for the first wave peaked at 1.54 (95% CI: 1.42-1.71) in the Centralregion and 1.64 (95% CI: 1.38-1.92) in the North, whilst the corresponding values in the North-Eastand the South were 1.30 (95% CI: 1.17-1.46) and 1.39 (95% CI: 1.32-1.45) respectively. As theR(t) in the Central region fell below one, the value of R(t) in the rest of Thailand increased aboveone. R(t) was above one for 30 days continuously through the first wave in all regions of Thailand.During the second wave R(t) was only marginally above one in all regions except the South.Conclusions: In Thailand, the value of R(t) varied by region in the two pandemic waves. HigherR(t) estimates were found in Central and Northern regions in the first wave. Knowledge of regionalvariation in transmission potential is needed for predicting the course of future pandemics and foranalysing the potential impact of control measures
