背景:在全球范围内,特别是在低收入和中等收入国家(LMICs),由于社区意识水平较低,农村人口更容易受到COVID-19大流行的负面影响,卫生条件差,和健康素养伴随着先前存在的薄弱的公共卫生系统。因此,在全球农村地区设计了各种基于社区的干预措施,通过使人们有能力采取个人和集体公共卫生应对措施来减轻COVID-19大流行.然而,到目前为止,关于任何大规模社区干预在控制和减轻COVID-19影响方面的有效性的信息很少,特别是从低收入国家的角度来看。
目的:这项回顾性影响评估研究旨在评估大规模农村社区干预的效果,无COVID村庄计划(CFVP),关于马哈拉施特拉邦农村人口的COVID-19弹性和控制,印度。
方法:干预地点是浦那地区的农村地区,CFVP于2021年8月至2022年2月实施,而毗邻地区,Satara,代表实施无COVID村庄计划的控制区。在2022年4月至5月期间,通过面对面访谈使用2阶段分层随机抽样,然后使用倾向得分匹配方法开发匹配样本,从干预和比较组的3500个样本家庭中收集数据。
结果:浦那的参与者的COVID-19综合意识指数明显高于Satara的参与者0.43分(95%CI0.29-0.58)。此外,坚持适合COVID的行为,包括洗手,与Satara相比,浦那的掩蔽高出23%(95%CI3%-45%),掩蔽高出17%(0%-38%)。与Satara相比,浦那将COVID视为严重疾病的可能性高出22%(95%CI1.036-1.439)。浦那的COVID-19变种和预防措施的意识指数也较高,为0.88分(95%CI0.674-1.089)。在亚组分析中,当最高的家庭教育水平被限制在中学时,浦那对COVID控制程序的认知度高出0.69(95%CI0.36-1.021)点,而COVID-19变种和预防措施的认知指数较高0.45(95%CI0.236~0.671)分。由于实施了CFVP,我们没有观察到COVID-19疫苗接种总体覆盖率有任何显著变化。此外,在两个样本人群中,COVID-19死亡人数都很低。浦那观察到与COVID-19相关的污名或歧视的概率比Satara低68%(95%CI0.133-0.191)。
结论:尽管没有证据表明COVID-19疫苗接种率提高或死亡率降低,但CFVP有助于提高大量人群对COVID适宜行为的认识和可持续性,标志着在未来大流行防备中的潜在适用性,尤其是在资源受限的环境中。
BACKGROUND: Globally, especially in the low- and middle-income countries (LMICs), rural populations were more susceptible to the negative impact of the COVID-19 pandemic due to lower levels of community awareness, poor hygiene, and health literacy accompanying pre-existing weak public health systems. Consequently, various community-based interventions were engineered in rural regions worldwide to mitigate the COVID-19 pandemic by empowering people to mount both individual and collective public health responses against the pandemic. However, to date, there is paucity of information on the effectiveness of any large-scale community intervention in controlling and mitigating the effects of COVID-19, especially from the perspective of LMICs.
OBJECTIVE: This retrospective impact evaluation study was conducted to evaluate the effect of a large-scale rural community-based intervention, the COVID-Free Village Program (CFVP), on COVID-19 resilience and control in rural populations in Maharashtra, India.
METHODS: The intervention site was the rural areas of the Pune district where CFVP was implemented from August 2021 to February 2022, while the adjoining district, Satara, represented the control district where the COVID-Free Village Scheme was implemented. Data were collected during April-May 2022 from 3500 sample households in villages across intervention and comparison arms by using the 2-stage stratified random sampling through face-to-face interviews followed by developing a matched sample using propensity score matching methods.
RESULTS: The participants in Pune had a significantly higher combined COVID-19 awareness index by 0.43 (95% CI 0.29-0.58) points than those in Satara. Furthermore, the adherence to COVID-appropriate behaviors, including handwashing, was 23% (95% CI 3%-45%) and masking was 17% (0%-38%) higher in Pune compared to those in Satara. The probability of perception of COVID as a serious illness in patients with heart disease was 22% (95% CI 1.036-1.439) higher in Pune compared to that in Satara. The awareness index of COVID-19 variants and preventive measures were also higher in Pune by 0.88 (95% CI 0.674-1.089) points. In the subgroup analysis, when the highest household educational level was restricted to middle school, the awareness about the COVID-control program was 0.69 (95% CI 0.36-1.021) points higher in Pune, while the awareness index of COVID-19 variants and preventive measures was higher by 0.45 (95% CI 0.236-0.671) points. We did not observe any significant changes in the overall COVID-19 vaccination coverage due to CFVP implementation. Furthermore, the number of COVID-19 deaths in both the sampled populations were very low. The probability of observing COVID-19-related stigma or discrimination in Pune was 68% (95% CI 0.133-0.191) lower than that in Satara.
CONCLUSIONS: CFVP contributed to improved awareness and sustainability of COVID-appropriate behaviors in a large population although there was no evidence of higher COVID-19 vaccination coverage or reduction in mortality, signifying potential applicability in future pandemic preparedness, especially in resource-constrained settings.