RESUMO
BackgroundThe Algerian COVID-19 vaccination campaign, which started by the end of January 2021, is marked by a slowly ascending curve despite the deployed resources. To tackle the issue, we assessed the levels and explored determinants of engagement towards the COVID-19 vaccine among the Algerian population. MethodsA nationwide, online-based cross-sectional study was conducted between March 27 and April 30, 2021. A two-stage stratified snowball sampling method was used to include an equivalent number of participants from the four cardinal regions of the country. A vaccine engagement scale was developed, defining vaccine engagement as a multidimensional parameter (5 items) that combined self-stated acceptance and willingness with perceived safety and efficacy of the vaccine. An Engagement score was calculated and the median was used to define engagement versus nonengagement. Sociodemographic and clinical data, perceptions about COVID-19 and levels of adherence to preventive measures were analyzed as predictors for nonengagement. ResultsWe included 1,019 participants, 54% were female and 64% were aged 18-29 years. Overall, there were low rates of self-declared acceptance (26%) and willingness (21%) to take the vaccine, as well as low levels of agreement regarding vaccine safety (21%) and efficacy (30%). Thus, vaccine engagement rate was estimated at 33.5%, and ranged between 29.6-38.5% depending on the region (p>0.05). Nonengagement was independently associated with female gender (OR=2.31, p<0.001), low adherence level to preventive measures (OR=6.93p<0.001), private sector jobs (OR=0.53, p=0.038), perceived COVID-19 severity (OR=0.66, p=0.014), and fear from contracting the disease (OR=0.56, p=0.018). Concern about vaccine side effects (72.0%) and exigence for more efficacy and safety studies (48.3%) were the most commonly reported barrier and enabler for vaccine acceptance respectively; whereas beliefs in the conspiracy theory were reported by 23.4%. ConclusionsThe very low rates of vaccine engagement among the Algerian population probably explain the slow ascension of the vaccination curve in the country. Vaccine awareness campaigns should be implemented to address the multiple misconceptions and enhance the levels of knowledge and perception both about the disease and the vaccine, by prioritizing target populations and engaging both healthcare workers and the general population.
RESUMO
BACKGROUND: Oral anticoagulation is associated with increased bleeding complications. The aim of this study was to assess the changes in menstrual loss and pattern in women taking anticoagulant treatment. STUDY DESIGN: Women on oral anticoagulant (OA) treatment at the Royal Free Hospital were interviewed and completed a questionnaire about their menstrual cycle before and after commencing oral anticoagulation treatment. They were then asked to complete a pictorial bleeding assessment chart (PBAC) during their next menstrual bleeding episode. RESULTS: Fifty-three women between the ages of 20 and 50 years participated in the study. Of these, 47 women completed a PBAC. The mean duration of menstruation increased from 5 days before starting OA therapy to 7 days after the commencement of treatment. Thirty-one (66%) of the 47 women who completed the PBAC had a score that was greater than 100. The number of women who experienced flooding or clots during menstruation and intermenstrual or postcoital bleeding also increased. In total, 29 (54.7%) women changed their method of contraception during OA treatment. Seventeen women who did not want to become pregnant were not using contraception, including 10 women who were on hormonal contraception prior to starting anticoagulant therapy. CONCLUSION: Women of reproductive age experience heavy and prolonged menstrual bleeding whilst on OA therapy. Women of reproductive age on OA therapy should be monitored for menstrual disorders to ensure that prompt and appropriate treatment is instituted. Advice about appropriate contraception should also be part of the medical care provided for these women. Barrier contraception, sterilization and progestin-only contraception are all suitable methods of contraception in this patient group.
