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Boven, A., Simin, J., Andersson, F. L., Vlieghe, E., Callens, S., Zeebari, Z., . . . Brusselaers, N. (2024). Clostridioides difficile infection, recurrence and the associated healthcare consumption in Sweden between 2006 and 2019: a population-based cohort study. BMC Infectious Diseases, 24(1), Article ID 468.
Open this publication in new window or tab >>Clostridioides difficile infection, recurrence and the associated healthcare consumption in Sweden between 2006 and 2019: a population-based cohort study
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2024 (English)In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 24, no 1, article id 468Article in journal (Refereed) Published
Abstract [en]

Background: Clostridioides difficile infection (CDI) causes a major burden to individuals and society, yet the impact may vary depending on age, sex, underlying comorbidities and where CDI was acquired (hospital or community). Methods: This Swedish nationwide population-based cohort study (2006–2019) compared all 43,150 individuals with CDI to their 355,172 matched controls (first year and entire follow-up). Negative binomial regression models compared the cumulated length of stay, number of in-hospital admissions, outpatient visits and prescriptions after the first CDI episode expressed as incidence rate ratios (IRR) and 95% confidence intervals for the entire follow-up. Results: Overall, 91.6% of CDI cases were hospital acquired, and 16.8% presented with recurrence(s); 74.8%of cases were ≥ 65 years and 54.2% were women. Compared to individuals without CDI, in-hospital stay rates were 18.01 times higher after CDI (95% CI 17.40–18.63, first-year: 27.4 versus 1.6 days), 9.45 times higher in-hospital admission (95% CI 9.16–9.76, first-year: 2.6 versus 1.3 hospitalisations), 3.94 times higher outpatient visit (95% CI 3.84–4.05, first-year: 4.0 versus 1.9 visits) and 3.39 times higher dispensed prescriptions rates (95% CI 3.31–3.48, first-year: 25.5 versus 13.7 prescriptions). For all outcomes, relative risks were higher among the younger (< 65 years) than the older (≥ 65 years), and in those with fewer comorbidities, but similar between sexes. Compared to those without recurrence, individuals with recurrence particularly showed a higher rate of hospital admissions (IRR = 1.18, 95% 1.12–1.24). Compared to community-acquired CDI, those with hospital-acquired CDI presented with a higher rate of hospital admissions (IRR = 7.29, 95% CI 6.68–7.96) and a longer length of stay (IRR = 7.64, 95% CI 7.07–8.26). Conclusion: CDI was associated with increased health consumption in all affected patient groups. The majority of the CDI burden could be contributed to hospital-acquired CDI (~ 9/10), older patients (~ 3/4) and those with multiple comorbidities (~ 6/10 Charlson score ≥ 3), with 1/5 of the total CDI burden contributed to individuals with recurrence. Yet, relatively speaking the burden was higher among the younger and those with fewer comorbidities, compared to their peers without CDI.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Burden, Clostridioides difficile, Health-economic, Healthcare consumption, Real world evidence, Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Clostridium Infections, Cohort Studies, Cross Infection, Female, Hospitalization, Humans, Incidence, Infant, Length of Stay, Male, Middle Aged, Patient Acceptance of Health Care, Recurrence, Sweden, Young Adult, acetylsalicylic acid, antibiotic agent, histamine H2 receptor antagonist, nonsteroid antiinflammatory agent, proton pump inhibitor, Article, Charlson Comorbidity Index, Clostridium difficile infection, cohort analysis, comorbidity, disease burden, follow up, health care access, hospital admission, human, major clinical study, outcome assessment, outpatient, prescription, recurrent disease, risk factor, Clostridium infection, patient attitude, preschool child, very elderly
National Category
Infectious Medicine
Identifiers
urn:nbn:se:hj:diva-64170 (URN)10.1186/s12879-024-09364-3 (DOI)001214184600003 ()38702635 (PubMedID)2-s2.0-85191974042 (Scopus ID)GOA;intsam:950589 (Local ID)GOA;intsam:950589 (Archive number)GOA;intsam:950589 (OAI)
Funder
Karolinska Institute
Available from: 2024-05-13 Created: 2024-05-13 Last updated: 2024-05-21Bibliographically approved
Enriquez, R., Homsi, M., Ssekubugu, R., Nabukalu, D., Zeebari, Z., Marrone, G., . . . Nordenstedt, H. (2024). Prevalence and risk factors of metabolic dysfunction-associated steatotic liver disease in south Central Uganda: A cross-sectional survey. Alimentary Pharmacology and Therapeutics
Open this publication in new window or tab >>Prevalence and risk factors of metabolic dysfunction-associated steatotic liver disease in south Central Uganda: A cross-sectional survey
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2024 (English)In: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Despite numerous risk factors and serious consequences, little is known about metabolic dysfunction-associated steatotic liver disease (MASLD) at population level in Africa. Aim: The aim of the study was to estimate the prevalence and risk factors of MASLD in people living with and without HIV in Uganda. Methods: We collected data from 37 communities in South Central Uganda between May 2016 and May 2018. We estimated MASLD prevalence using the fatty liver index and advanced liver fibrosis using the dynamic aspartate-to-alanine aminotransferase ratio. We collected additional data on sociodemographics, HIV and cardiovascular disease (CVD) risk factors. We used multivariable logistic regression to determine the association between HIV, CVD risk factors and MASLD. Results: We included 759 people with HIV and 704 HIV-negative participants aged 35–49. MASLD prevalence was 14% in women and 8% in men; advanced liver fibrosis prevalence was estimated to be <1%. MASLD prevalence was more common in women (15% vs. 13%) and men (9% vs. 6%) with HIV. Being female (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.4–3.3) was associated with a higher odds of MASLD after adjustment for confounders; HIV infection was borderline associated with MASLD (OR = 1.4; 95% CI: 1.0–2.0). Conclusions: In a relatively young cohort in Uganda, 14% of women and 8% of men had MASLD. There was an indication of an association between HIV and MASLD in multivariable analysis. These data are the first to describe the population-level burden of MASLD in sub-Saharan Africa using data from a population-based cohort.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
HIV, metabolic dysfunction-associated steatotic liver disease, metabolic syndrome, sub-Saharan Africa
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-63856 (URN)10.1111/apt.17931 (DOI)001181391600001 ()38459720 (PubMedID)2-s2.0-85187152843 (Scopus ID)HOA;intsam;942846 (Local ID)HOA;intsam;942846 (Archive number)HOA;intsam;942846 (OAI)
Available from: 2024-03-20 Created: 2024-03-20 Last updated: 2024-03-20
Hartmann, M., Giovenco, D., Zeebari, Z., Itzikowitz, G., Ekström, A. M., Nielsen, A., . . . Kågesten, A. E. (2023). Associations between psychosocial wellbeing and experience of gender-based violence at community, household, and intimate-partner levels among a cross-sectional cohort of young people living with and without HIV during COVID-19 in Cape Town, South Africa. BMC Public Health, 23(1), Article ID 2115.
Open this publication in new window or tab >>Associations between psychosocial wellbeing and experience of gender-based violence at community, household, and intimate-partner levels among a cross-sectional cohort of young people living with and without HIV during COVID-19 in Cape Town, South Africa
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2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 2115Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Growing evidence indicates that gender-based violence (GBV) increased during COVID-19. We investigated self-reported impact of the pandemic on GBV at community, household and intimate partner (IPV) levels among young people and its associations with psychosocial wellbeing, i.e., COVID-related stressors and mental health.

METHODS: Cross-sectional data were drawn from a survey with young people ages 13-24 (N = 536) living with HIV (YPLWH) and without HIV (YPLWoH), in peri-urban Cape Town, South Africa. The survey, conducted February-October 2021, examined the impact of the initial lockdown on experience and perceived changes in GBV at each level, and pandemic-related psychosocial wellbeing. Descriptive statistics and binomial and multinomial regression analyses were conducted to illustrate exposure and perceived changes in GBV since lockdown, and their association with COVID-related stress factors (e.g., social isolation, anxiety about COVID), mental health (e.g., depression, anxiety), and other risk factors (e.g., age, gender, socioeconomic status) by HIV status.

RESULTS: Participants were 70% women with mean age 19 years; 40% were living with HIV. Since lockdown, YPLWoH were significantly more likely than YPLWH to perceive community violence as increasing (45% vs. 28%, p < 0.001), and to report household violence (37% vs. 23%, p = 0.006) and perceive it as increasing (56% vs. 27%, p = 0.002) (ref: decreasing violence). YPLWoH were also more likely to report IPV experience (19% vs. 15%, p = 0.41) and perception of IPV increasing (15% vs. 8%, p = 0.92). In adjusted models, COVID-related stressors and common mental health disorders were only associated with household violence. However, indicators of economic status such as living in informal housing (RRR = 2.07; 95% CI = 1.12-3.83) and food insecurity (Community violence: RRR = 1.79; 95% CI = 1.00-3.20; Household violence: RRR = 1.72; 95% CI = 1.15-2.60) emerged as significant risk factors for exposure to increased GBV particularly among YPLWoH.

CONCLUSIONS: Findings suggest that for young people in this setting, GBV at community and household levels was more prevalent during COVID-19 compared to IPV, especially for YPLWoH. While we found limited associations between COVID-related stressors and GBV, the perceived increases in GBV since lockdown in a setting where GBV is endemic, and the association of household violence with mental health, is a concern for future pandemic responses and should be longitudinally assessed.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
COVID-19, COVID-19-related stress, Gender-based Violence, HIV, young people, Mental health, South Africa, Violence
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-62811 (URN)10.1186/s12889-023-16945-5 (DOI)001094219700002 ()37891509 (PubMedID)2-s2.0-85175090056 (Scopus ID)GOA;intsam;913020 (Local ID)GOA;intsam;913020 (Archive number)GOA;intsam;913020 (OAI)
Funder
Swedish Research Council
Available from: 2023-10-30 Created: 2023-10-30 Last updated: 2023-12-01Bibliographically approved
Canabarro, A. P. F., Eriksson, M., Nielsen, A., Zeebari, Z. & Salazar, M. (2023). Cognitive social capital as a health-enabling factor for STI testing among young men in Stockholm, Sweden: A cross-sectional population-based study. Heliyon, 9(10), Article ID e20812.
Open this publication in new window or tab >>Cognitive social capital as a health-enabling factor for STI testing among young men in Stockholm, Sweden: A cross-sectional population-based study
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2023 (English)In: Heliyon, E-ISSN 2405-8440, Vol. 9, no 10, article id e20812Article in journal (Refereed) Published
Abstract [en]

Objective: To assess whether different forms of cognitive social capital increased the relative probability of testing for sexually transmitted infections (STIs) among young men living in Stockholm, Sweden.

Methods: A population-based cross-sectional study was conducted in 2017 with men aged 20–29 years living in Stockholm County, Sweden (n = 523). The main outcome was STI testing patterns (never tested, tested only within a 12-month period, tested only beyond a 12-month period, repeatedly tested). The main exposure were two forms of cognitive social capital: social support (having received help, having someone to share inner feelings with) and institutionalized trust (in school, healthcare, media). Data were analyzed using weighted multivariable multinomial logistic regression to obtain adjusted weighted relative probability ratio (aRPR).

Results: After adjusting for confounding factors, receiving help (aRPR: 5.2, 95% CI: 1.7–16.2) and having someone to share inner feelings with (aRPR: 3.1, 95% CI: 1.2–7.7) increased the relative probabilities of young men testing for STIs, but only for those testing beyond a 12-month period. Trust in media increased the relative probability of STI testing for those testing only within a 12-month period (aRPR: 2.6, 95% CI: 1.1–6.1) and for those testing repeatedly (aRPR: 3.6, 95% CI: 1.5–8.8).

Conclusion: Young men in Stockholm County exhibit distinct STI testing patterns. Social support and trust in media were factors that increased the probability of being tested for STIs, with this effect varying according to the young men's STI testing pattern. Further studies are required to explore how trust in media might promote STI testing in this population.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
HIV testing, Sexually transmitted diseases, Social capital, Social support, Sweden, Trust
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-62804 (URN)10.1016/j.heliyon.2023.e20812 (DOI)001149577200001 ()37876418 (PubMedID)2-s2.0-85174465180 (Scopus ID)GOA;;912781 (Local ID)GOA;;912781 (Archive number)GOA;;912781 (OAI)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-00594
Available from: 2023-10-30 Created: 2023-10-30 Last updated: 2024-02-12Bibliographically approved
Zeebari, Z. & Shukur, G. (2023). On the least absolute deviations method for ridge estimation of SURE models. Communications in Statistics - Theory and Methods, 52(14), 4773-4791
Open this publication in new window or tab >>On the least absolute deviations method for ridge estimation of SURE models
2023 (English)In: Communications in Statistics - Theory and Methods, ISSN 0361-0926, E-ISSN 1532-415X, Vol. 52, no 14, p. 4773-4791Article in journal (Refereed) Published
Abstract [en]

In this paper we examine the application of the Least Absolute Deviations (LAD) method for ridge-type parameter estimation of Seemingly Unrelated Regression Equations (SURE) models. The methodology is aimed to deal with the SURE models with non-Gaussian error terms and highly collinear predictors in each equation. Some biasing parameters used in the literature are taken and the efficiency of both Least Squares (LS) ridge estimation and the LAD ridge estimation of the SURE models, through the Mean Squared Error (MSE) of parameter estimators, is evaluated.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
SURE Models, LAD Estimation, Ridge Regression, Efficiency, Robustness
National Category
Probability Theory and Statistics
Identifiers
urn:nbn:se:hj:diva-19682 (URN)10.1080/03610926.2012.755203 (DOI)000836635900001 ()2-s2.0-85073873825 (Scopus ID)
Note

Included in doctoral thesis in manuscript form.

Available from: 2012-10-24 Created: 2012-10-24 Last updated: 2023-05-30Bibliographically approved
Zeebari, Z., Månsson, K., Sjölander, P. & Söderberg, M. (2023). Regularized conditional estimators of unit inefficiency in stochastic frontier analysis, with application to electricity distribution market. Journal of Productivity Analysis, 59, 79-97
Open this publication in new window or tab >>Regularized conditional estimators of unit inefficiency in stochastic frontier analysis, with application to electricity distribution market
2023 (English)In: Journal of Productivity Analysis, ISSN 0895-562X, E-ISSN 1573-0441, Vol. 59, p. 79-97Article in journal (Refereed) Published
Abstract [en]

In stochastic frontier analysis, the conventional estimation of unit inefficiency is based on the mean/mode of the inefficiency, conditioned on the composite error. It is known that the conditional mean of inefficiency shrinks towards the mean rather than towards the unit inefficiency. In this paper, we analytically prove that the conditional mode cannot accurately estimate unit inefficiency, either. We propose regularized estimators of unit inefficiency that restrict the unit inefficiency estimators to satisfy some a priori assumptions, and derive the closed form regularized conditional mode estimators for the three most commonly used inefficiency densities. Extensive simulations show that, under common empirical situations, e.g., regarding sample size and signal-to-noise ratio, the regularized estimators outperform the conventional (unregularized) estimators when the inefficiency is greater than its mean/mode. Based on real data from the electricity distribution sector in Sweden, we demonstrate that the conventional conditional estimators and our regularized conditional estimators provide substantially different results for highly inefficient companies.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Uncertainty modelling, Productivity, Regularized Estimators, Constrained Estimators, Conditional Estimators
National Category
Economics Mathematical Analysis
Identifiers
urn:nbn:se:hj:diva-59105 (URN)10.1007/s11123-022-00651-2 (DOI)000894403900001 ()2-s2.0-85143340899 (Scopus ID)HOA;;846720 (Local ID)HOA;;846720 (Archive number)HOA;;846720 (OAI)
Available from: 2022-12-07 Created: 2022-12-07 Last updated: 2023-02-20Bibliographically approved
Jalloh, M. F., Zeebari, Z., Nur, S. A., Prybylski, D., Nur, A. A., Hakim, A. J., . . . Nordenstedt, H. (2022). Drivers of COVID-19 policy stringency in 175 countries and territories: COVID-19 cases and deaths, gross domestic products per capita, and health expenditures.
Open this publication in new window or tab >>Drivers of COVID-19 policy stringency in 175 countries and territories: COVID-19 cases and deaths, gross domestic products per capita, and health expenditures
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2022 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: To understand the associations of COVID-19 cases and deaths with policy stringency globally and regionally.

Methods: We modeled the marginal effects of new COVID-19 cases and deaths on policy stringency (scored 0–100) in 175 countries and territories, adjusting for gross domestic product (GDP) per capita and health expenditure (% of GDP). Time periods examined were March–August 2020, September 2020– February 2021, and March–August 2021.

Results: Policy response to new cases and deaths was faster and more stringent early in the COVID-19 pandemic (March–August 2020) compared to subsequent periods. New deaths were more strongly associated with stringent policies than new cases. In an average week, 1 new death per 100,000 people was associated with a stringency increase of 2.1 units in March–August 2020, 1.3 units in September 2020–February 2021, and 0.7 units in March–August 2021. New deaths in Africa and the Western Pacific were associated with more stringency than in other regions. Higher health expenditure was associated with less stringent policies. GDP per capita did not have consistent patterns of associations with stringency.

Conclusions: Our findings demonstrate the need for enhanced mortality surveillance to ensure policy alignment during health emergencies. Countries that invest less of their GDP in health are inclined to enact stringent policies during health emergencies than countries with more significant health expenditure.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-59104 (URN)10.1101/2022.07.05.22277269 (DOI)POA;intsam;846717 (Local ID)POA;intsam;846717 (Archive number)POA;intsam;846717 (OAI)
Note

Published 7 July, 2022, on medRxiv, a preprint server for health sciences.

Available from: 2022-12-07 Created: 2022-12-07 Last updated: 2022-12-07
Jalloh, M. F., Zeebari, Z., Nur, S. A., Prybylski, D., Nur, A. A., Hakim, A. J., . . . Nordenstedt, H. (2022). Drivers of COVID-19 policy stringency in 175 countries and territories: COVID-19 cases and deaths, gross domestic products per capita, and health expenditures. Journal of Global Health, 12, Article ID 05049.
Open this publication in new window or tab >>Drivers of COVID-19 policy stringency in 175 countries and territories: COVID-19 cases and deaths, gross domestic products per capita, and health expenditures
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2022 (English)In: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 12, article id 05049Article in journal (Other academic) Published
Abstract [en]

Background: New data on COVID-19 may influence the stringency of containment policies, but these potential effect are not understood. We aimed to understand the associations of new COVID-19 cases and deaths with policy stringency globally and regionally.

Methods: We modelled the marginal effects of new COVID-19 cases and deaths on policy stringency (scored 0-100) in 175 countries and territories, adjusting for gross domestic product (GDP) per capita and health expenditure (% of GDP), and public expenditure on health. The time periods examined were March to August 2020, September 2020 to February 2021, and March to August 2021.

Results: Policy response to new cases and deaths was faster and more stringent early in the COVID-19 pandemic (March to August 2020) compared to subsequent periods. New deaths were more strongly associated with stringent policies than new cases. In an average week, one new death per 100 000 people was associated with a stringency increase of 2.1 units in the March to August 2020 period, 1.3 units in the September 2020 to February 2021 period, and 0.7 units in the March to August 2021 period. New deaths in Africa and the Western Pacific were associated with more stringency than in other regions. Higher health expenditure as a percentage of GDP was associated with less stringent policies. Similarly, higher public expenditure on health by governments was mostly associated with less stringency across all three periods. GDP per capita did not have consistent patterns of associations with stringency.

Conclusions: The stringency of COVID-19 policies was more strongly associated with new deaths than new cases. Our findings demonstrate the need for enhanced mortality surveillance to ensure policy alignment during health emergencies. Countries that invest less in health or have a lower public expenditure on health may be inclined to enact more stringent policies. This new empirical understanding of COVID-19 policy drivers can help public health officials anticipate and shape policy responses in future health emergencies.

Place, publisher, year, edition, pages
International Society of Global Health (ISoGH), 2022
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-59279 (URN)10.7189/jogh.12.05049 (DOI)36527269 (PubMedID)2-s2.0-85144586053 (Scopus ID)GOA;intsam;59279 (Local ID)GOA;intsam;59279 (Archive number)GOA;intsam;59279 (OAI)
Available from: 2023-01-03 Created: 2023-01-03 Last updated: 2023-01-03Bibliographically approved
Winters, M., Biermann, O., Bohlin, G., Bergman, M., Brouneus, F., Zeebari, Z. & Nordenstedt, H. (2022). Media use and trust during the COVID-19 pandemic: evidence from eight cross-sectional surveys in Sweden. European Journal of Public Health, 32(6), 976-981
Open this publication in new window or tab >>Media use and trust during the COVID-19 pandemic: evidence from eight cross-sectional surveys in Sweden
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2022 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 6, p. 976-981Article in journal (Refereed) Published
Abstract [en]

Background

While a lot has been written about Sweden's COVID-19 control strategy, less is known about Swedish residents' media use during the pandemic and trust in and perceived agreement among key stakeholders commenting in the media.

Methods

Eight online, nationwide surveys were fielded between March and August 2020, during the first wave of the coronavirus pandemic in Sweden, with 8146 responses. Questions were asked on media usage, perceived tone of media, trust in key pandemic stakeholder groups commenting in the media (politicians, journalists, government officials, doctors/healthcare professionals and researchers) and perceived agreement among these key stakeholders about how the pandemic was handled in Sweden.

Results

Using five or more information sources was associated with increased perceived alarmism in the media. Women and those with tertiary education were more likely to trust key pandemic actors. Trust in doctors/healthcare professionals and researchers remained high over the course of the study, trust in politicians and journalists was relatively low throughout the study period, with a slight increase in April 2020. Trust in key stakeholders was strongly associated with perceived agreement among the key stakeholders.

Conclusions

Our results show that trust in stakeholders was strongly associated with perceived consistency of messages from those stakeholders. The inverse also holds: perceived conflicting messages among stakeholders was associated with low trust in them. Taken together, this could point to the importance of building trust before a crisis. Trust-building efforts could be targeted to men and those with lower educational attainment, as they had lower trust in key stakeholders.

Place, publisher, year, edition, pages
Oxford University Press, 2022
National Category
Public Health, Global Health, Social Medicine and Epidemiology Media and Communications
Identifiers
urn:nbn:se:hj:diva-58723 (URN)10.1093/eurpub/ckac145 (DOI)000866178800001 ()36223605 (PubMedID)2-s2.0-85154047365 (Scopus ID)HOA;;839481 (Local ID)HOA;;839481 (Archive number)HOA;;839481 (OAI)
Funder
Wenner-Gren Foundations, SA2020-0006Swedish Research CouncilAnne-Marie and Gustaf Anders Foundation for Media Research
Available from: 2022-10-27 Created: 2022-10-27 Last updated: 2023-05-08Bibliographically approved
Winters, M., Oppenheim, B., Sengeh, P., Jalloh, M. B., Webber, N., Pratt, S. A., . . . Nordenstedt, H. (2021). Debunking highly prevalent health misinformation using audio dramas delivered by WhatsApp: evidence from a randomised controlled trial in Sierra Leone. BMJ Global Health, 6(11), Article ID e006954.
Open this publication in new window or tab >>Debunking highly prevalent health misinformation using audio dramas delivered by WhatsApp: evidence from a randomised controlled trial in Sierra Leone
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2021 (English)In: BMJ Global Health, Vol. 6, no 11, article id e006954Article in journal (Refereed) Published
Abstract [en]

Introduction Infectious disease misinformation is widespread and poses challenges to disease control. There is limited evidence on how to effectively counter health misinformation in a community setting, particularly in low-income regions, and unsettled scientific debate about whether misinformation should be directly discussed and debunked, or implicitly countered by providing scientifically correct information.

Methods The Contagious Misinformation Trial developed and tested interventions designed to counter highly prevalent infectious disease misinformation in Sierra Leone, namely the beliefs that (1) mosquitoes cause typhoid and (2) typhoid co-occurs with malaria. The information intervention for group A (n=246) explicitly discussed misinformation and explained why it was incorrect and then provided the scientifically correct information. The intervention for group B (n=245) only focused on providing correct information, without directly discussing related misinformation. Both interventions were delivered via audio dramas on WhatsApp that incorporated local cultural understandings of typhoid. Participants were randomised 1:1:1 to the intervention groups or the control group (n=245), who received two episodes about breast feeding.

Results At baseline 51% believed that typhoid is caused by mosquitoes and 59% believed that typhoid and malaria always co-occur. The endline survey was completed by 91% of participants. Results from the intention-to-treat, per-protocol and as-treated analyses show that both interventions substantially reduced belief in misinformation compared with the control group. Estimates from these analyses, as well as an exploratory dose–response analysis, suggest that direct debunking may be more effective at countering misinformation. Both interventions improved people’s knowledge and self-reported behaviour around typhoid risk reduction, and yielded self-reported increases in an important preventive method, drinking treated water.

Conclusion These results from a field experiment in a community setting show that highly prevalent health misinformation can be countered, and that direct, detailed debunking may be most effective.

Trial registration number NCT04112680.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2021
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hj:diva-55146 (URN)10.1136/bmjgh-2021-006954 (DOI)000752477500001 ()34758970 (PubMedID)2-s2.0-85119504007 (Scopus ID)GOA;intsam;778364 (Local ID)GOA;intsam;778364 (Archive number)GOA;intsam;778364 (OAI)
Funder
Swedish Research Council, 2017-05581European Commission
Note

Data are available in a public, open access repository.

Available from: 2021-11-23 Created: 2021-11-23 Last updated: 2022-02-17Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-2733-4441

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