COVID-19 hospital admissions and deaths after BNT162b2 and ChAdOx1 nCoV-19 vaccinations in 2·57 million people in Scotland (EAVE II):a prospective cohort study

EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE—The Health Data Research Hub for Respiratory Health [MC_PC_19004], which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. UA, CM, AA-L, and AFF acknowledge funding from Chief Scientist Office Rapid Research in COVID-19 programme (COV/SAN/20/06) and Health Data Research UK (measuring and understanding multimorbidity using routine data in the UK—HDR-9006; CFC0110). SVK acknowledges funding from a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and the Scottish Government's Chief Scientist Office (SPHSU17). SJS is funded by a Wellcome Trust Clinical Career Development Fellowship (209560/Z/17/Z).Background  The UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020–21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despite social distancing measures being in place. We aimed to estimate the frequency of COVID-19 hospitalisation or death in people who received at least one vaccine dose and characterise these individuals. Methods  We conducted a prospective cohort study using the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) national surveillance platform, which contained linked vaccination, primary care, RT-PCR testing, hospitalisation, and mortality records for 5·4 million people (around 99% of the population) in Scotland. Individuals were followed up from receiving their first dose of the BNT162b2 (Pfizer–BioNTech) or ChAdOx1 nCoV-19 (Oxford–AstraZeneca) COVID-19 vaccines until admission to hospital for COVID-19, death, or the end of the study period on April 18, 2021. We used a time-dependent Poisson regression model to estimate rate ratios (RRs) for demographic and clinical factors associated with COVID-19 hospitalisation or death 14 days or more after the first vaccine dose, stratified by vaccine type. Findings Between Dec 8, 2020, and April 18, 2021, 2 572 008 individuals received their first dose of vaccine—841 090 (32·7%) received BNT162b2 and 1 730 918 (67·3%) received ChAdOx1. 1196 (<0·1%) individuals were admitted to hospital or died due to COVID-19 illness (883 hospitalised, of whom 228 died, and 313 who died due to COVID-19 without hospitalisation) 14 days or more after their first vaccine dose. These severe COVID-19 outcomes were associated with older age (≥80 years vs 18–64 years adjusted RR 4·75, 95% CI 3·85–5·87), comorbidities (five or more risk groups vs less than five risk groups 4·24, 3·34–5·39), hospitalisation in the previous 4 weeks (3·00, 2·47–3·65), high-risk occupations (ten or more previous COVID-19 tests vs less than ten previous COVID-19 tests 2·14, 1·62–2·81), care home residence (1·63, 1·32–2·02), socioeconomic deprivation (most deprived quintile vs least deprived quintile 1·57, 1·30–1·90), being male (1·27, 1·13–1·43), and being an ex-smoker (ex-smoker vs non-smoker 1·18, 1·01–1·38). A history of COVID-19 before vaccination was protective (0·40, 0·29–0·54). Interpretation COVID-19 hospitalisations and deaths were uncommon 14 days or more after the first vaccine dose in this national analysis in the context of a high background incidence of SARS-CoV-2 infection and with extensive social distancing measures in place. Sociodemographic and clinical features known to increase the risk of severe disease in unvaccinated populations were also associated with severe outcomes in people receiving their first dose of vaccine and could help inform case management and future vaccine policy formulation.Publisher PDFPeer reviewe

Women's education and fertility in Islamic countries

Education is the main driving force of development, autonomy and demographic change. It provides women access to modern ways of thinking, confidence to engage with the modern world, reduces infant mortality, raises age at marriage and stimulates higher levels of gender equity within couple relationships. Schooling is also positively related with more favorable attitudes towards birth control, greater knowledge of contraception, and husband-wife communication. It also promotes female labour force participation in the cash economy hence raising the opportunity cost of having children. This chapter, first, discusses the value that Islam places on women�s education, and presents the trend of female education in Muslim-majority countries. Second, country level differences as well as gender gap in education and the reasons for this diversity are reviewed. Third, fertility change in Islamic countries and the pathways by which female education has had impact on fertility is examined. The result shows that the level of women�s education has increased substantially in most of the Islamic world and women have higher access to formal schooling and acquire information through various means of communication. Thus, there is a need to reconsider many of the stereotypes indicating that Muslim societies for religious reason discriminate against women. As a consequence of educational achievements, the traditional values and norms have been weakened, although in many cases there is strong resistance to these influences. Considerable fertility decline occurred in these countries can be explained by the improvements in female education that has strongly affected the supply and the demand for children as well as fertility regulations

Women's human capital and economic growth in the Middle East and North Africa

The process of demographic transition has increased the share of the working-age population in Middle East and North Africa (MENA). This situation has created an opportunity for economic growth, called the demographic dividend. Global comparisons show that a favorable age structure has not always resulted in a boost in economic growth. In order to take a full advantage of the MENA's demographic dividend, it is important to identify different factors contributing to economic growth in this region. Investment in women's human capital is expected to have important implications for the region's economic growth and for maximizing the benefits created by the demographic dividend. Using a range of data sources, this paper aims to determine the association between women's human capital (measured by adult educational attainment and health status) and economic growth (measured by gross national income per capita) in MENA. The findings show a positive association between these two. Specifically, the national-level income is generally higher in countries with lower maternal mortality and higher female literacy, female tertiary education, female life and healthy life expectancies at birth and professional childbirth attendance. Thus, investment in women's human capital can accelerate the pace of development in MENA