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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Motivational Factors and Post Vaccination Symptoms among COVID-19 Vaccinated Beneficiaries at a Tertiary Care Hospital, West Bengal, India: A Cross-sectional Study
Correspondence Address :
Dr. Maumita De,
32/1 B, Garpar Road, Post Office: Amherst Street,
Kolkata-700009, West Bengal, India.
E-mail: drmaumita80@gmail.com
Introduction: Since, the emergence of Coronavirus Disease-2019 (COVID-19) pandemic, there has been an intense burden on the health system and economy worldwide with millions of people being affected leading to several deaths. In this scenario vaccination seems to be a hope to control the pandemic. However, fear of adverse events following immunisation sometimes makes people hesitant about vaccination.
Aim: To assess the spectrum of post vaccination symptoms and also to identify the motivational factors along with their determinants at a tertiary care hospital, West Bengal, India.
Materials and Methods: A cross-sectional study was conducted in the COVID-19 Vaccination Centre at Nil Ratan Sircar Medical College and Hospital, Kolkata West Bengal, India (tertiary care hospital), from August to November 2021. A total of 448 vaccinated beneficiaries were enrolled in the study. Data collection was done by an online questionnaire, sent to the participants in their registered mobile numbers. Descriptive statistics and Chi-square tests were used for data analysis.
Results: Among 448 study participants, 262 (58.5%) were in 18-44 years of age group, 248 (55.4%) female, 384 (85.7%) Hindu, 132 (29.5%) medical or paramedical students, 290 (64.7%) passed graduation and above and 306 (68.3%) belonged to nuclear family. About 228 (50.9%) beneficiaries reported post vaccination symptoms. Most common being local pain at injection site, found among 150 (65.8%) out of them. Most common motivational factors of COVID-19 vaccination were found to be fear of COVID-19 infection, reported by 274 (61.2%) participants, which showed significant difference with various age groups (p-value=0.001), religions (p-value=0.030), occupations (p-value<0.001) and educations (p-value=0.002). Statistical significant (p<0.05) differences were also found according to age, gender, co-morbidities, interval between vaccination and past COVID-19 infection and type of COVID-19 vaccine in relation to onset of post vaccination symptoms.
Conclusion: Following COVID-19 immunisation minor adverse events were reported. Monitoring of those adverse events will help in further responding and prompt action. Also, the knowledge about motivational factors is expected to reduce vaccine hesitancy among unvaccinated people.
Adverse events, Coronavirus disease-2019, Immunisation, Pandemic
The current pandemic due to Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), known as COVID-19,, has emerged as a catastrophe, putting immense pressure on the health and economic system worldwide (1),(2). In this scenario, effective vaccine seemed to offer the only hope (2),(3),(4).
In India, three vaccines, Covishield, Covaxin and Sputnik V, have got approval from the Drug Controller General of India (5). The vaccine schedule was two doses for each vaccine. Nationwide vaccination programme started on 16th January 2021 with healthcare workers being the first group of beneficiaries to receive the vaccine. It was gradually expanded to include the frontline workers, senior citizens and eventually to all adults (18 years and above) (5).
One of the greatest challenges of this vaccination programme was the acceptance of the vaccine by the general population. Undue fear of any adverse events and confusion about the efficacy of the vaccines were identified as the main determining factors for successful vaccination programme (6),(7),(9). Several studies based on the ‘health belief model’ and ‘protection motivation theory’ has revealed some factors affecting the vaccine acceptance viz. perception of risk due to the disease, safety, efficacy, cost of the vaccine, past history of vaccination, physician’s recommendation and the attitude and sociodemographic characteristics of the population (10),(11),(12),(13),(14).
Though, vaccines are an important tool in public health, helping in prevention and control of several diseases, vaccination may lead to reactions like other drugs (3). Though, these reactions are mostly non severe, it interferes with a person’s confidence in vaccines. Various factors like awareness regarding vaccines, religious and socio-political issues, fear of associated risks and socio-economic factors may alter the attitude of an individual towards vaccination (15),(16),(17).
Several studies have been conducted to find the factors affecting willingness to get vaccinated, but most of them were community based studies (17),(18). Since, this study was conducted among the beneficiaries vaccinated at a COVID-19 Vaccination Centre, it will help us to assess the motivating factors for vaccination and its determinants. This may help in raising public awareness. Fear of side effects is one of the important causes of vaccine hesitancy. Thus, knowledge regarding the post vaccination symptoms will help to educate the people regarding the adverse effects, which will help to allay the fear and increase the acceptance of COVID-19 vaccine, which may ultimately lead to increased coverage and curb the pandemic.
Hence, the following study was conducted to find out the Post Vaccination Symptoms (PVS) and to assess the motivational factors of COVID-19 vaccination among the beneficiaries attending the COVID-19 Vaccination Centre (CVC) of a tertiary care hospital in West Bengal, India.
A cross-sectional study was conducted in the COVID-19 Vaccination Centre at Nil Ratan Sircar Medical College and Hospital, Kolkata West Bengal, India (tertiary care hospital), from August to November 2021. After receiving Institutional Ethics Committee approval (Vide Memo No: NRSMC/IEC/04/2021, Dated: 20.07.2021), permission was sought for obtaining informed verbal consent from the participants considering the feasibility issues, since online questionnaire was sent. The participants were assured of their anonymity and confidentiality of the given information.
Inclusion criteria: The beneficiaries, who attended the COVID-19 Vaccination Centre and were vaccinated with atleast one dose of any COVID-19 vaccine were included in the study.
Exclusion criteria: Vaccinated person who were severely ill and also the beneficiaries or any of their family members who were unable to read, type and understand in english and also incompletely filled up the Google form were excluded from the study.
Sample size calculation: Based on a study finding by Kamal D et al., 57% of recipients reported atleast one or more adverse events following COVID-19 immunisation, anticipated P was 57% (19). Assuming confidence level of 95% and absolute precision of 5%, the minimum required sample size was calculated as 392. Considering 10% non response rate, the minimum required sample size was 432. Beneficiaries attending the vaccination centre on any single day of the week were selected randomly. Considering average turnover to be 280 beneficiaries per day, the beneficiaries were selected by systematic random sampling and every 10th beneficiary was chosen. Hence, a sample size of 448 beneficiaries, who have filled up the questionnaires completely was selected for final study.
Questionnaire
A survey questionnaire was prepared by the authors initially after review of literature related to adverse events of COVID-19 vaccine and motivational factors for COVID-19 vaccination (17),(19),(20),(21). Content validity and face validity of this study tool was checked by the experts from Departments of Community Medicine, General Medicine and Respiratory Medicine. Reliability of the study questionnaire was assessed and Cronbach’s alpha value measured was 0.74. This pretested and predesigned questionnaire by means of online Google form was sent to the participants in their registered mobile numbers. The questionnaire consisted of five parts.
• First part: It consisted of six questions on socio-demographic variables
Age
Gender
Religion
Occupation
Education
Type of family
• Second part: It included three questions related to clinical history of the patient:
Co-morbidity status
Medication history
Past history of COVID-19 infection
• Third part: It contained three questions on COVID-19 vaccination history:
Type of COVID-19 vaccine (Covishield or Covaxin, because these two vaccines were only available in the study institution during data collection period),
Number of doses taken,
Interval between vaccination and past COVID-19 infection (if any).
• Fourth part: It included four questions pertaining to details of the post vaccination symptoms (if any), their onset of development and duration of symptoms.
• Fifth part: It incorporated question on motivational factors for vaccination, where 12 options like fear of disease or hospitalisation, availability of vaccine at free of cost, social media effect, self motivation, others etc. were given for ‘yes’ or ‘no’ subjective responses.
Statistical Analysis
All collected data were compiled and analysed by Microsoft excel 16.0 and Epi info 7.2.4. Results were presented in proportions (%) and Chi-square test of significance was applied. The significance level was fixed as p-value <0.05.
In the present study, most of the participants like 262 (58.5%) were in 18-44 years of age group, 248 (55.4%) female, 384 (85.7%) were Hindu by religion. Among the vaccinated population maximum i.e. 132 (29.5%) were medical or paramedical students, 290 (64.7%) passed graduation and above and 306 (68.3%) belonged to nuclear family (Table/Fig 1).
A total 138 (30.8%) out of 448 study population were suffering from associated co-morbidities, whereas 10 (2.2%) people did not know about their disease status. Common co-morbidity was found to be hypertension 64 (14.3%) followed by diabetes 40 (8.9%), thyroid disease 26 (5.8%), heart disease 14 (3.1%), lung disease 8 (1.8%), renal disease and neurological disease 4 (0.9% each) (Table/Fig 2). Among 138 diseased subjects, 116 (84.1%) were taking regular medications. Total 72 (16.1%) out of 448 of the participants had suffered from COVID-19 infections in the past before vaccination.
Among 448 participants 114 (25.4%) has taken Covaxin and 334 (74.6%) taken Covishield. Among all vaccinated persons 382 (85.3%) have completed second dose of vaccination. Out of 72 participants with past history of COVID-19 infections, most of them 60 (83.3%) have taken vaccines after 3 months of COVID-19 infection (Table/Fig 3).
It has been found that 228 (50.9%) out of 448 study population reported any post vaccination symptom. Most common symptom was found to be local pain at injection site 150 (65.8%) followed by tiredness or lethargy 102 (44.7%). Least common PVS reported to be breathing problem and painful swollen gland 2 (0.8% each) (Table/Fig 4). Most of the vaccinated patients like 178 (39.7%) developed PVS within two days of vaccination. As reported by the participants, most like 161 (35.9%) among them suffered from PVS for one to three days (Table/Fig 5).
Most common motivational factors of COVID-19 vaccination were found to be fear of COVID-19 infection 274 (61.2%), availability of vaccine at free of cost 153 (34.2%), self-motivated 140 (31.3%) and fear of hospitalisation 120 (26.8%) (Table/Fig 6).
Factors related to Post Vaccination Symptoms (PVS): It has been found that onset of PVS among study population differ significantly (p-value<0.05) according to their age (p-value<0.001), gender (p-value=0.019), co-morbidities (p-value=0.014), interval between COVID-19 vaccination and past COVID-19 infection (p-value=0.006) and type of COVID-19 vaccine (p-value=0.010) (Table/Fig 7).
There is statistically significant difference (p-value <0.05) found in relation to duration of PVS with interval between COVID-19 vaccination and past COVID-19 infection (p-value <0.001) and also with type of COVID-19 vaccine (p-value=0.014) (Table/Fig 8).
Some background characteristics like age group, gender, religion, occupation, education and co-morbidities were statistically tested against most common four motivational factors and the results have been depicted in (Table/Fig 9). Only yes responses (%) regarding motivational factors are mentioned in the (Table/Fig 9). It has been seen that fear of COVID-19 infection significantly different (p-value <0.05) among different age groups (p-value=0.001), religions (p=0.030), occupations (p-value <0.001) and educations (p-value=0.002). There was statistically significant difference found in relation to fear of hospitalisation with gender (p-value=0.025), occupation (p-value <0.001) and education (p-value=0.021). COVID-19 vaccination due to self-motivation varied significantly in relation to participants’ age group (p-value <0.001), gender (p-value <0.001), religions (p-value=0.039), occupations (p-value <0.001), educations (p-value=0.002) and co-morbidities (p-value=0.001) also. While considering availability of COVID-19 vaccine at free of cost, it is significantly different according to age group (p-value <0.001), gender (p-value=0.019), occupation (p-value=0.044) and education (p-value <0.001).
Other eight motivational factors also statistically tested against above mentioned background characteristics and the test results are mentioned in (Table/Fig 10). It has been found that motivation due to easy vaccine availability significantly vary according to occupation (p-value <0.001) and education (p-value=0.046). People with different age group (p-value<0.001), gender (p-value <0.001), religion (p-value=0.005), occupation (p-value<0.001) and education (p-value=0.019) significantly motivated for COVID-19 vaccination on family history of hospitalisation or death due to COVID-19. Influence of family or friends to get vaccinated found to be significantly different according to age (p-value<0.001), education (p-value<0.001) and co-morbidities (p-value=0.001). There was significant variation in age (p-value=0.012) and occupation (p-value<0.001) due to motivation by family physician’s advice. It has been found that fear of death varied significantly according to age group (p-value=0.026), gender (p-value=0.006), occupation (p-value=0.002) and presence of comorbidities (p-value=0.023). Participants with varied occupation (p-value<0.001) and education (p-value=0.010) significantly motivated due to trust on healthcare providers. Social media could motivate significantly for vaccination only due to presence of co-morbidities (p-value<0.001). No participants got significantly motivated by community health workers.
In this study about 16% of the participants suffered from past COVID-19 infections and majority (83.3%) of them took vaccines after three months of infections. Similarly a study performed in Czech Republic stated that 19.3% vaccinated individuals had been previously infected by COVID-19, but the median latency period between the recovery date and the first vaccine dose was 65 days (22).
In the present study, Covishield was taken by 75% of the people compared to 25% taken Covaxin. It may be due to more supply of this particular vaccine in West Bengal state of India. Comparison between proportion and distribution of post vaccination symptoms of the present study with the contrast studies are incorporated in (Table/Fig 11) (3),(19),(20),(21).
About 39.7% of the vaccinated beneficiaries developed PVS within two days of vaccination. Parallel findings were reported by Kamal D et al., (19). In the present study, most (35.9%) of the participants suffered from PVS for one to three days and only 0.9% for more than seven days. Almost similar findings suggested by Riad A et al., regarding the duration of side-effects (22).
After review of literature the socio-demographic factors like age, gender, co-morbidities were found relevant with PVS, hence these factors were checked for significance level with PVS (19),(22),(23). Again no such references were found indicating PVS varied according to other socio-demographic variables like religion, occupation, education and type of family. In present study, the onset of PVS among participants differ significantly (p-value <0.05) according to their age, gender, co-morbidities, interval between COVID-19 vaccination and past COVID-19 infection and type of COVID-19 vaccine. The onset of PVS in another study among healthcare workers was inversely correlated with the age group (r-value=-0.202; p-value=0.033), and directly correlated with the total number of non communicable diseases (r-value=0.018; p-value=0.914) (22).
Although, the biological mechanism for the higher incidence of PVS among female is not clear, it may be related to genes, hormones, environmental and immunologic factors (23). However, no peerreviewed published data has been found declaring the association of PVS with type of COVID-19 vaccine. This study could not find statistical significance according to age and co-morbidities with duration of PVS. But in another study, the duration of side-effects was significantly and directly correlated with age (r-value=0.097; p-value=0.006), the number of medical treatments (r-value=0.122; p-value<0.05) and the number of side-effects (r-value=0.256; p-value<0.001) (22).
Since, this study was a hospital based study among people attending to get vaccinated, vaccine acceptance was 100%. Higher and lower levels of acceptance were found across the different countries which have been tabulated in (Table/Fig 12) (24),(25),(26),(27),(28),(29),(30).
The most common motivational factors of vaccination in this study were fear of COVID-19 infection (61.2%), availability of vaccine at free of cost (34.2%), self-motivation (31.3%) and fear of hospitalisation (26.8%). World Health Organisation (WHO) report has identified almost similar factors for COVID-19 immunisation (31). Another research by Kalam MA et al., also corroborated with this findings of the present study (32).
The present study found that motivational factors significantly vary (p-value <0.05) among different age, gender, religions, occupations, educations and persons with co-morbidities. A study conducted by Jacob J et al., in India revealed that willingness for COVID-19 vaccination was strongly associated (p-value <0.01) with income, past COVID-19 infection, perceived risk of COVID-19 infection, trust in authority, cost of vaccine and safety of vaccine (33). The socio-demographic factors were also found significant for pandemic vaccine acceptability in Bangladesh, US and Japan (34),(35),(36).
The major strength of this study was, it reflected the vaccinated individuals with different socio-demographic variables in West Bengal, India. It also tried to explore the factors influencing onset and duration of post vaccination symptoms, which can help further to identify the priority groups needed special attention at vaccination centres and also to advise the vaccinated people beforehand to allay their fear of side-effects.
Limitation(s)
One of the few limitations of this study was being a hospital based study, it included only the vaccinated individuals. Thus, the true proportion of vaccine acceptance could not be assessed. Another methodological limitation was use of online questionnaire, which may cause self-selection bias due to filling up only by the highly motivated participants. The self reporting of collected data may introduce information bias.
Most of the adverse events following COVID-19 immunisation were reported to be mild and self-limited and predominantly duration of symptom was shorter within 72 hours. This message should be percolated to reduce the worries about unforeseen side-effects of COVID-19 vaccine. While the higher motivational factors were found to be the fear of COVID-19 infection or self-motivation, messages from social media or community health workers were negligible. So, these modes of communications must be enhanced and directed to all community people to prevent spread of misinformation. Due to the hospital setting of the study the vaccine acceptance was full. But a community based study is highly recommended to explore the reasons of vaccine hesitancy; which ultimately improves the COVID-19 vaccination drives in India in large.
Authors would like to express our heartfelt gratitude to the hospital authorities for their kind support during the research work. Authors are thankful to the participants for their patience and co-operation to complete the online questionnaire.
DOI: 10.7860/JCDR/2022/57598.17027
Date of Submission: May 06, 2022
Date of Peer Review: Jun 18, 2022
Date of Acceptance: Aug 08, 2022
Date of Publishing: Oct 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No
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