Global prevalence and correlates of mpox vaccine acceptance and uptake: a systematic review and meta-analysis.

BACKGROUND: Vaccination has been recommended as one of the most potent ways of controlling the mpox (formerly, monkeypox) outbreak, particularly among high-risk groups. Here, we evaluated the prevalence of mpox vaccine acceptance and uptake globally. METHODS: We searched multiple databases for peer-reviewed studies published in English from May 2022 to 25th November 2023 that evaluated mpox vaccine acceptance and/or uptake. We fit a random-effects model meta-analysis to calculate the pooled mpox vaccine acceptance and uptake rates, with their 95% confidence intervals (CI) across population outcomes. We performed subgroup analyses among the six World Health Organization (WHO) regions (Africa [AFR], Region of the Americas [AMR], South-East Asia Region [SEAR], European Region [EUR], Eastern Mediterranean Region [EMR], and the Western Pacific Region [WPR]), as well as among select population subgroups. RESULTS: Of the 2531 studies screened, 61 studies, with a cumulative sample size of 263,857 participants from 87 countries were eligible for inclusion. The overall vaccine acceptance and uptake rates were 59.7% and 30.9% globally. Acceptance and uptake rates among the LGBTQI+ community were 73.6% vs 39.8% globally, 60.9% vs. 37.1% in AMR, 80.9% vs. 50.0% in EUR, and 75.2% vs. 33.5% in WPR. Among PLHIV, vaccine acceptance and uptake rates were 66.4% vs. 35.7% globally, 64.0% vs. 33.9% in AMR, 65.1% vs. 27.0% in EUR, and 69.5% vs. 46.6% in WPR. Among healthcare workers, vaccination intention was 51.0% globally. CONCLUSIONS: Tailored interventions are needed to bolster confidence in the mpox vaccine, maximize vaccine uptake, and increase vaccine access to close the gaps between acceptance and uptake especially among key populations residing in regions with low rates of acceptance and uptake.

Mpox is an infection caused by the monkeypox virus and is transmitted through direct contact with infected animals or people, or indirectly through contact with contaminated materials. An unprecedented mpox outbreak spanning all continents occurred in 2022. Vaccination against the infection by high-risk groups, including the LGBTQI+ community and frontline healthcare workers has been recommended by the WHO as essential to outbreak control. To investigate the rates and factors associated with mpox vaccine acceptance and uptake across population subgroups (LGBTQI+ community, healthcare workers, people living with HIV, and the general public), we undertook this global systematic review and meta-analysis of the available evidence. Our results reveal substantial global and regional variations in the rates of mpox vaccine acceptance and uptake across population groups, with wide acceptance-uptake gaps, indicating the need for behavioral interventions to increase mpox vaccine confidence and uptake.

Depression mediates the relationship between exposure to stigma and medication adherence among people living with HIV in low-resource setting: a structural equation modeling approach.

This study hypothesizes that depression mediates the association between exposure to stigma and medication non-adherence in people living with HIV (PLHIV). We recruited 372 PLHIV from the Stigma, health-related Quality of life, antiretroviral Adherence, and Depression among people living with HIV (SQuAD-HIV) project, a multicenter cross-sectional study conducted between October 2021 and February 2022 among PLHIV attending six ART clinics in two geopolitical regions of northern Nigeria. A structural equation modeling (SEM) framework, utilizing the full information maximum likelihood estimator, was used to elucidate the pathways linking stigma, depression, and ART medication adherence, adjusting for sociodemographic characteristics. The total number of eligible participants analyzed (353) included 32.7% male PLHIV with a mean age (SD) of 39.42 (10.14). Being female was positively associated with adherence (ß, 95% CI 0.335, 0.163-0.523, p-value < 0.001) but negatively associated with stigma (ß, 95% CI - 0.334, - 0.561 to - 0.142, p-value = 0.001), while urban residence was negatively associated with stigma (ß, 95% CI - 0.564, - 0.804 to - 0.340, p-value < 0.001). Our analysis also indicated that a higher level of experienced stigma was associated with decreased medication adherence. This association was partially mediated by depression (indirect effect = (0.256) (- 0.541) = - 0.139; p-value < 0.01). The proportion of the association between stigma and medication adherence explained through mediation by depression was 35.6%. These findings underscore the need for targeted interventions aimed at lowering exposure to stigma among PLHIV to improve medication adherence.

A systematic review and meta-analysis of the global prevalence and determinants of COVID-19 vaccine acceptance and uptake in people living with HIV.

People living with HIV (PLHIV) are at higher risk of poor outcomes of SARS-CoV-2 infection. Here we report the pooled prevalence of COVID-19 vaccine acceptance/uptake and determinants among this vulnerable population of PLHIV based on a systematic review and meta-analysis of studies published by 25 August 2023. Among the 54 included studies (N = 167,485 participants), 53 (N = 166,455) provided data on vaccine acceptance rate, while 27 (N = 150,926) provided uptake data. The global prevalences of COVID-19 vaccine acceptance and uptake were 67.0% and 56.6%, respectively. Acceptance and uptake rates were 86.6% and 90.1% for the European Region, 74.9% and 71.6% for the Region of the Americas, 62.3% and 78.9% for the South-East Asian Region, 64.6% and 19.3% for the Eastern Mediterranean Region, 58.0% and 35.5% for the African Region, and 57.4% and 44.0% for the Western Pacific Region. The acceptance rate increased from 65.9% in 2020 to 71.0% in 2022, and the uptake rate increased from 55.9% in 2021 to 58.1% in 2022. Men, PLHIV aged ≥40 years and those who had recently received the influenza vaccine were more likely to accept and receive the COVID-19 vaccine. Factors associated with lower uptake included Black race, other races (Latinx/Hispanic/mixed race), low education level and being unemployed. Vaccine-related factors associated with higher acceptance included belief in vaccine effectiveness, vaccine trust, perceived high susceptibility to SARS-CoV-2 infection and fear of potential COVID-19 effect in PLHIV. Sustained efforts and targeted interventions are needed to reduce regional disparities in COVID-19 vaccine uptake among PLHIV.

Perceived changes in the mental well-being among Nigerians due to Ramadan Intermittent Fasting during the COVID-19 pandemic.

INTRODUCTION: Muslims fast every year during the month of Ramadan from dawn until dusk. This study examined mental well-being and correlating factors among Nigerian adults who observed Ramadan intermittent fasting (RIF). METHODS: A validated generalized anxiety disorder-2 and Patient Health Questionnaire-2, the four-item spiritual well-being index, and the Islamic intrinsic religiosity questionnaire were used to collect data about mental well-being (depression, anxiety), spirituality, and intrinsic religiosity through a web-based survey between the May 9, 2021 (27th of Ramadan, 1442) and the June 4, 2021 (29th of Shawwal, 1442). We studied the mental well-being of respondents over a period of 4 weeks before Ramadan (BR) and during the 4 weeks of Ramadan between the April 12, 2021 and the May 12, 2021(DR). Multinomial regression analysis was used to determine the factors associated with depression and anxiety. This research did not receive any grant or funding. RESULTS: A total of 770 adult Nigerians who observed RIF study were included in this cross-sectional study. When compared to mental well-being BR, observing RIF by Nigerian adult respondents was associated with a significant improvement in their mental well-being. A higher proportion of respondents felt less depressed DR (61.3% vs. 56.5%. < .001). Interest and pleasure in doing things improved DR than BR (p= 0.007) and respondents felt less nervous and anxious (60.7% vs. 57.1%, respectively; p <.001). Mental well-being was independently associated with sociodemographic characteristics, physical activity, and perceived relationships. CONCLUSIONS: This study found significant improvement in mental well-being DR compared to BR despite the ongoing COVID-19 pandemic. The effect of RIF on mental well-being needs further research with multicentric studies among different sets of ethnic populations.

The effect of mobile phone utilization for enhanced adherence counselling intervention among persons with HIV.

The conduct of physical enhanced adherence counselling (EAC) for antiretroviral therapy (ART) non-adherers is often flawed by objectionable time lag from commencement to timely completion of the process. Therefore, we conducted a retrospective cohort study of 342 adults (≥18 years) with HIV on ART to determine the outcome of utilizing mobile phone based EAC intervention. Structural equation modelling framework, with full information maximum likelihood estimator was used to elucidate the pathways linking the relationship between individual characteristics, perceived barriers to ART adherence, and the applied interventions. A total of 321(93.9%) participants completed the required 3 EAC sessions over 60-days. The proportion of viral load (VL) re-suppression (<1000 copies/mL) after EAC intervention was 66.6%. The mean durations of EAC onset from time of high VL confirmation and completion of EAC were 6.26 ± 3.22 and 59.99 ± 5.14 days, respectively. In the simultaneous model (Comparative Fit Index = 0.89, Tucker-Lewis Index = 0.851, Root Mean Square (RMS) Error of Approximation = 0.049, Standardized RMS Residual = 0.059), the variables: forgot, knowledge/beliefs, side effect of drugs, lost/ran out of drugs, scheduling, and stigma were significant barrier factors contributing to poor ART adherence. The use of mobile phones for EAC intervention was effective for early initiation and timely completion of the sessions.

A systematic review and meta-analysis of the prevalence of caregiver acceptance of malaria vaccine for under-five children in low-income and middle-income countries (LMICs).

INTRODUCTION: Malaria is the second leading cause of death in children after diarrheal disease, with low- and middle-income countries (LMICs) accounting for over 9 in 10 incidence and deaths. Widespread acceptance and uptake of the RTS,S vaccine, recently approved by the world health organization (WHO), is projected to significantly reduce malaria incidence and deaths. Therefore, we conducted this systematic review and meta-analysis with the aim to determine the malaria vaccine acceptance rate and the factors associated with acceptance. METHODS: We searched six databases including Google Scholar, PubMed, Cochrane, African Index Medicus, The Regional Office for Africa Library, and WHO Institutional Repository for Information Sharing (IRIS) to identify studies evaluating the malaria vaccine acceptance rate. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Studies were included if they were original articles published in the English language in peer-reviewed journals and assessed the prevalence of willingness to accept a free malaria vaccine, and not qualitative. The risk of publication bias was checked using both Beggar's funnel plot and Egger's test, while the I2 statistic was used to assess the heterogeneity of the included studies. Study quality was determined using the Newcastle-Ottawa scale. A meta-analysis was performed using a random effects model to evaluate the pooled prevalence of malaria vaccine acceptance. The protocol for this article was registered prospectively on the International Prospective Register for Systematic Reviews (PROSPERO), with ID number CRD42022334282). RESULTS: Our analysis included 11 studies with a total sample size of 14, 666 participants. The aggregate malaria vaccine acceptance rate was 95.3% (95% CI:93.0%-97.2%). Among the general population, the acceptance rate was 96.3% (95% CI:92.0%-99.0%) and among mothers, it was 94.4% (95% CI:90.8%-97.2%). By country, Nigeria had the highest acceptance rate (97.6%, 95% CI:96.0%-98.8%), followed by Ghana (94.6%, 95% CI:93.8%-95.3%) and Tanzania (92.5%, 95% CI:84.4%-97.8%). Sociodemographic determinants of vaccine acceptance included place of residence, tribe, age, sex, occupation, and religion. Reasons for low acceptance included safety concerns, efficacy profile, vaccine's requirement for multiple injections, and poor level of awareness. CONCLUSION: Future efforts should be focused on identifying factors that may improve the actual uptake of the RTS,S vaccine in malaria-endemic communities.

Nigerian Muslim's Perceptions of Changes in Diet, Weight, and Health Status during Ramadan: A Nationwide Cross-Sectional Study.

The Islamic month of Ramadan is marked by fasting, when Muslims refrain from eating and drinking from dawn to sunset, which has an impact on their dietary habits. The study aimed to assess Nigerian Muslims' dietary modifications during Ramadan and their related changes in body weight and health status. A web-based cross-sectional study was conducted among Nigerian adult Muslims. The survey assessed sociodemographic, dietary habits, eating behaviors, food choices, perceived weight changes, and health status. The logistic regression model was used to assess the predictors of weight change and perceived health status. There were 770 participants, 62.9% of whom were women, ranging in age from 18 to 60 years with a mean age of 27.7 ± 6.4 years. Fruits, palm dates, homemade foods, milk products, and vegetables were more frequently consumed. There were fewer energy drinks, pastries, salty snacks, and carbonated or sugared drinks consumed during Ramadan than before. Over half (54.6%, 95% CI: 51.0-58.9%) of the respondents lost weight during Ramadan, 37.0% (95% CI: 17.4-38.6%) maintained their weight and 8.4% (95% CI: 6.6-10.6%) gained weight during the month. Nearly all (97.3%, 95% CI: 95.8-98.3%) reported having good health during Ramadan, and 2.7% (95% CI: 1.7-4.1%) reported having a poorer health state during Ramadan. There was a significant weight loss and healthy dietary change associated with Ramadan fasting in Nigeria. Public health measures must be in place to impart such positive health behaviors so that such healthy habits continue throughout the year.